Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8227
Revised: October 13, 2013
Accepted: October 19, 2013
Published online: December 7, 2013
Antiviral therapy consisting of interferon-alpha and ribavirin for chronic hepatitis C infection is associated with multi-system side-effects. Ophthalmologic complications are common and can be classified into two groups: interferon-associated retinopathy and atypical adverse events. Interferon-associated retinopathy has been investigated by multiple observational studies that have found widely divergent results. The clinical importance of this complication is, consequently, controversial. This review examines the literature with the specific goal of identifying the most important ophthalmologic issues facing the hepatologist prescribing antiviral therapy. Accordingly, it assesses the incidence of interferon-associated retinopathy, as well as its risk factors, pathogenesis, clinical manifestations and options for management using data from the observational studies. The likely benefit of a screening program, especially one targeting patients with the highest risk of developing interferon-associated retinopathy, is analysed. Atypical ophthalmologic adverse events occur less frequently than interferon-associated retinopathy during antiviral therapy for chronic hepatitis C infection. They often, however, lead to irreversible vision loss. We examine the reports of these adverse events - in individual case reports or case series and in the observational studies investigating interferon-associated retinopathy - to describe the spectrum of these adverse events, the likely outcome for patients and to highlight the most important areas of future clinical research.
Core tip: Interferon-associated retinopathy is usually a benign, transient phenomenon with no lasting impact on visual function. It occurs in approximately 30% of patients receiving antiviral therapy for chronic hepatitis C infection. The main risk factors for its development appear to be hypertension and diabetes. Unless a clear benefit to patients can be shown, a screening program for the development of interferon-associated retinopathy is not justified. No conclusive evidence exists for a causal link between it and the atypical adverse events of antiviral therapy, which tend to cause irreversible vision loss.