Did you know that patients with hepatitis C, being treated with pegylated interferon (one of the most accepted treatment regimens) might be subject to severe retinopathy?
Diligence is warranted with any patient with hepatitis C. If you uncover a patient afflicted with hepatitis C, ask about their treatment regimen. Treatment with pegylated interferon alpha (PegIFNα) and ribavirin is still regarded as the standard of care for chronic hepatitis C virus. Retinopathy has been occasionally described but prospective, longitudinal data had been lacking until a study reported this past summer in Hepatology journal.
S. Vujosevic, et. al. investigated the frequency and clinical significance of retinopathy during therapy with PegIFNα and ribavirin in hepatitis C patients. 55.7% of a patient sample treated with PegIFNα 2a and 44.3% of a patient sample treated with PegIFNα 2b were followed with ophthalmologic examinations performed before therapy, at three and six months of therapy, and three months after the end of therapy.
Overall, 30.9% of patients developed retinopathy, as defined by the presence of cotton wool spots and/or retinal hemorrhages. Variables significantly associated with retinopathy during treatment were age, metabolic syndrome, and preexisting intraocular lesions. By multivariate analysis, the only variable independently associated with PegIFNα-associated retinopathy was hypertension. The frequency of retinopathy was significantly higher in hypertensive patients versus those without hypertension. In fact, one hypertensive patient developed bilateral branch retinal vein occlusion at six months of therapy; as a result, the therapy was discontinued.
The authors report that a cost analysis showed that screening for PegIFNα-associated retinopathy was cost-effective. Their conclusion, which has implications for any PegIFNα-treated hepatitis C patient, is that retinopathy is frequent during treatment especially in hypertensive patients, who may develop serious complications. Screening for PegIFNα-associated retinopathy is recommended for all hepatitis C patients with hypertension.
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Excerpts reprinted with permission of Hepatology journal. 2012 Aug; 56(2):455-63. “Pegylated interferon-associated retinopathy is frequent in hepatitis C virus patients with hypertension and justifies ophthalmologic screening.” Authors: Vujosevic S, Tempesta D, Noventa F, Midena E, and Sebastiani G.
Tom Cockley is president of Gulden Ophthalmics and is the third generation of the nearly 75-year-old visionary company that brings innovative, time-saving, utilitarian products to vision and health care professionals.
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