title: Transient visual loss in a hepatitis C patient treated with pegylated interferon alfa-2a and ribavirin.
abstract: BACKGROUND
  Patients with Hepatitis C are commonly treated with combination of Pegylated Interferon alfa-2a and Ribavirin. Less than 1% of patients receiving this treatment experience very uncommon ophthalmological side effects such as optic neuropathy and vision disorder, which are usually subclinical, mild and reversible, not requiring the withdrawal of the treatment. Retinopathy is the most commonly reported ocular side effect of interferon use, usually presenting with cotton wool spots and retinal hemorrhages.
  
  
  METHODS
  We represent a case of severe retinopathy and optic neuropathy in a patient with chronic hepatitis C genotype 3a infection, treated with the combination of PEG-IFN alfa-2a (180 mkg once weekly) and Ribavirin (1200 mg daily). Bilateral visual loss of both eyes developed at 11th week of therapy and changes in retina and optic nerve were observed. Fluorescein angiography and optical coherence tomography showed bilateral anterior ischemic optic neuropathy and macular edema. Visual acuity improved 1 month and fundoscopic changes were no longer present 6 months after the urgent permanent discontinuation of PEG-IFN treatment and the pulse steroid therapy followed by a 2 week course of oral prednisone.
  
  
  CONCLUSIONS
  In case of interferon-associated retinopathy discontinuation of the therapy and treatment with high dose steroids can be beneficial. The prognosis of interferon-associated opthalmological side effects remains uncertain: in some patients visual acuity improves, other continues with poor visual outcome. Considering that, all patients should undergo ophthalmologic examination before treatment with interferon and their ophthalmological status should be monitored regularly while receiving this therapy.
authors.affiliation: Department of Infectious, Chest Diseases, Dermatovenerology and Alergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
authors.forename: Ligita
authors.initials: L
authors.lastname: Jancoriene
authors.affiliation: Department of Otolaryngology and Eye Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
authors.forename: Dovile
authors.initials: D
authors.lastname: Norvydaite
authors.affiliation: Department of Otolaryngology and Eye Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
authors.forename: Saulius
authors.initials: S
authors.lastname: Galgauskas
authors.affiliation: Department of xx, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
authors.forename: Evelina
authors.initials: E
authors.lastname: Balciunaite
keywords: Hepatitis C, Chronic; Optic Nerve Diseases; Peginterferon alfa-2a; Pulse Therapy, Drug