Table 2.
Main features of HCV-infected patients with intraocular vascular complications under PEG-IFN and ribavirin treatment
| Main features | Case 4 | Case 5 | Case 6 | Case 7 | Case 8 |
| Age (yr) | 51 | 70 | 55 | 40 | 40 |
| Sex | M | M | F | M | M |
| HCV genotype | 1 | 2 | |||
| Liver biopsy (Metavir) | ND | F4 | A2F1 | A2F2 | F4 (clinical cirrhosis) |
| Antecedents | Sarcoidosis | Arterial hypertension | - | Splenic lymphoma with villous lymphocytes | Hypertension with past hypertensive retinopathy |
| Smoking | Mixed cryoglobulin- associated glomerulonephritis | ||||
| Severe arterial hypertension | |||||
| Dyslipidemia, smoking | |||||
| Anti-HCV therapy | PEG-IFN α-2b + Ribavirin | PEG-IFN α-2b + Ribavirin | PEG-IFN α-2b + Ribavirin | Standard IFN α-2b + ribavirin | Standard IFN α-2b + Ribavirin |
| Interval before first ocular manifestations | 7 mo | 5 mo | 6 mo | 18 mo | 6 mo |
| Ocular manifestations | -Initial visual acuity: OD (< 20/200), OS (20/20) | -OD vision loss (20/200 OD; 20/20 OS) | -Bilateral vision loss (20/400 OD, 20/80 OS) | -Visual acuity OS: 10/10; OD: < 20/200 | -Bilateral vision loss (20/64 P2 OD, 20/200 OS) |
| -Papillar edema, macular edema and retinal hemorrhages | -Bilateral macular edema and retinal hemorrhages | ||||
| -Cotton wool spots | -Cotton-wool spots (IFN-α-induced retinopathy) (Figure 1A and B) | ||||
| Diagnosis | Central retinal vein occlusion OD | Central retinal vein occlusion OD | Acute anterior ischemic optic neuritis | Central retinal artery occlusion OD | Exsudative hypertensive and IFN -induced retinopathy |
| Treatment | -Withdrawal of PEG-IFN and ribavirin | -Withdrawal of PEG-IFN and ribavirin | -Withdrawal of PEG-IFN and ribavirin | -Withdrawal of standard IFN and ribavirin | -Withdrawal of standard IFN and ribavirin |
| -Steroids and IV heparin | -Steroids, IV heparin and aspirin | -Steroids | -Steroids and IV heparin | -Better control of hypertension (nadolol, benazepril) | |
| Course | -6 mo later, radiary neurotomy | -2 mo later, radiary neurotomy | -At the end of follow-up, severe visual impairment (< 20/400 OD; 20/80 OS) | -4 mo later, slow improvement (20/64 OD) | -2 mo later, significant improvement of the visual acuity (20/40 OD; 20/40 OS) |
| -At the end of follow-up, definitive loss of vision OD (< 20/200) | -At the end of follow-up, definitive vision loss OD | -Died of severe sepsis 5 mo later | -Introduction of PEG- IFN α-2b and Ribavirin without recurrence after more than 1 yr follow-up |