Is screening for interferon retinopathy in hepatitis C justified?

Area of Science:

• Ophthalmology
• Hepatology
• Pharmacology

Background:

• Hepatitis C treatment guidelines recommend interferon and ribavirin.
• Interferon therapy can cause retinopathy, characterized by retinal hemorrhages and cotton wool spots.
• Pegylated interferon is a long-acting form used for hepatitis C treatment.

Purpose of the Study:

• To determine the incidence and natural history of retinopathy in patients receiving pegylated interferon and ribavirin for hepatitis C.
• To evaluate the necessity of screening for retinal complications in these patients.

Main Methods:

• Prospective study of patients starting pegylated interferon and ribavirin from September 2002 to August 2003.
• Ophthalmological assessment at 3 months post-treatment initiation, including history, visual symptoms, and fundus examination.
• Follow-up of patients with retinal changes at 3-month intervals until resolution.

Main Results:

• Four out of 25 patients (16%) exhibited retinopathy, including retinal hemorrhages and cotton wool spots.
• Two patients had diabetes, and one had hypertension; none reported visual symptoms.
• All retinopathy cases resolved spontaneously during the course of treatment.

Conclusions:

• The incidence of retinopathy associated with pegylated interferon treatment for hepatitis C is low.
• Retinal complications are asymptomatic and resolve while treatment continues.
• Routine screening for retinopathy is not supported for patients on pegylated interferon and ribavirin for hepatitis C.