Interferon-alpha toxicity and reversible bilateral optical neuropathy: A timely withdrawal of the drug

• Published in: Archivos de la Sociedad Española de Oftalmología (English ed.) Vol. 89; no. 4; pp. 146 - 151
• Main Authors: Pérez-Carro, G, Fernández-Alonso, R, González-Diéguez, M.L, Rodríguez-García, M, Junceda-Moreno, J
• Format: Journal Article
• Language: English
• Published: Elsevier España 01.04.2014
• Subjects: Chronic hepatitis due to VHC; Evoked visual potentials; Hepatitis crónica por VHC; Interferón alfa pegilado; Latencia prolongada; Neuropatía óptica tóxica; Ophthalmology; Pegylated interferon alpha; Potenciales evocados visuales; Prolonged latency; Toxic optical neuropathy; Chronic hepatitis due to VHC; Pegylated interferon alpha; Toxic optical neuropathy; Latencia prolongada; Hepatitis crónica por VHC; Evoked visual potentials; Potenciales evocados visuales; Neuropatía óptica tóxica; Interferón alfa pegilado; Prolonged latency
• ISSN: 2173-5794; 2173-5794
• DOI: 10.1016/j.oftale.2014.06.007

Abstract Clinical case A patient with chronic, painless, bilateral loss of vision, after significant intake of interferon-α (IFNα) and ribavirina due to liver transplant. Ocular fundus is normal. A suspected retrobulbar optic neuropathy is confirmed by a prolongation of the latency of the patient's visual evoked potential. There being no prior record of risk factors and with the patient's systemic analysis giving normal results, the clinical improvement and the electro-physiological tests conducted after the drug was withdrawn point to interferon as negatively affecting the bilateral optic nerve. Discussion Interferon-α is used in the treatment of viral and neoplastic illnesses. Currently the drug is formulated as pegylated interferon alpha (IFNα-p) in order to reduce toxicity and increase tolerance. The most common secondary effects are flu symptoms, asthenia and weigh loss. Affected ocular tissue is rare and optic neuropathy is also an infrequent complication: retinopathy at the beginning of treatment is, however, more frequent. The most widely accepted hypothesis as to the cause of toxicity is the presence of circulating immune complexes. It is, therefore, essential for ophthalmologists to be aware of the toxicity of this drug in order to be able to withdraw it in good time, thus preventing potentially irreversible sight loss.