[Reversible Perimacular Retinopathy by Long-Time Interferon alpha Therapy].
BACKGROUND
Recently interferon therapy has become increasingly important in the treatment of viral and malignant diseases. Subsequently, a variety of adverse effects of interferon use has been reported. Ocular complications following interferon therapy include retinal ischaemia with cotton wool spots, retinal haemorrhages, capillary nonperfusion, vasospasm, and arteriolar occlusion.


METHODS
A 37-year old male complained about increasingly blurred vision in his right eye. Because of a chronic type B hepatitis he has been treated with interferon alpha for a total of 35 weeks. Visual acuity was slightly reduced (OD cc 0.9, OS cc 1.0 p). Dilated fundus examination and fluorescein angiography showed an incipient ischaemic retinopathy with perimacular arteriolar alterations in both eyes and single cotton wool spots in his right eye. Perimetry showed a slight reduction of the mean deviation. Amsler-grid did not show any pathology. As the retinopathy was thought to be related to the interferon treatment, it was decided to discontinue this therapy immediately. 2 weeks later visual acuity was improved (OD cc 1.25 p, OS cc 1.0) and dilated fundus examination showed no signs of perimacular ischaemic retinopathy and the initial cotton wool spots had been resolved.


CONCLUSIONS
In patients with long-time interferon treatment non-specific visual complaints like blurred vision or dark spots might be symptoms of an early ischaemic retinopathy. Retinal alterations might be reversible if treatment is discontinued. If an ischaemic retinopathy is present it should be considered to abandon interferon therapy, since permanent loss of vision has been described in advanced capillary non-perfusion and arteriolar occlusion. However, the decision to discontinue the interferon therapy should be made interdisciplinary while considering diagnosis and therapy indication.
Sandner
Dirk
D
Klinik und Poliklinik für Augenheilkunde der Carl-Gustav-Carus-Universität Dresden. Dirk.Sandner@mailbox.tu-dresden.de
Pillunat
Lutz E
LE
D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D007279:Injections, Subcutaneous; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use; D007511:Ischemia / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D008134:Long-Term Care; D008297:Male; D011092:Polyethylene Glycols; D011994:Recombinant Proteins; D012075:Remission, Spontaneous; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a