Limits...
Mixed vascular occlusion in a patient with interferon-associated retinopathy.

Bajaire BJ, Paipilla DF, Arrieta CE, Oudovitchenko E - Case Rep Ophthalmol (2011)

Bottom Line: Some case series suggest that in most cases the clinical course of the disease is benign, asymptomatic and without long-term consequences and therefore do not recommend any specific treatment; they only recommend the discontinuation of INF in patients with severe manifestations or risk factors such as hypertension or diabetes mellitus.These varieties of occlusive vascular events have not yet been found simultaneously in the literature and neither with an unfavorable clinical course.The magnitude and severity of the consequences associated with INF therapy are to be determined in prospective further studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Vitreous and Retina, San Martin University, Bogota, Colombia.

ABSTRACT
Interferon (INF)-associated retinopathy occurs in 15-64% of INF-treated patients, transforming this complication into a significant risk for visual impairment. This retinopathy has been described as an ocular complication with a variable clinical course, usually benign and asymptomatic. The most common findings are hemorrhages and cotton wool spots. Atypical ocular side effects include branch or central retinal artery occlusion, central retinal vein occlusion, anterior ischemic optic neuropathy, optic disc edema, neovascular glaucoma and vitreous hemorrhage. Some case series suggest that in most cases the clinical course of the disease is benign, asymptomatic and without long-term consequences and therefore do not recommend any specific treatment; they only recommend the discontinuation of INF in patients with severe manifestations or risk factors such as hypertension or diabetes mellitus. The case reported here presents an atypical manifestation of INF-associated retinopathy consisting of a mixed retinal vascular occlusion (arterial and venous), associated with severe occlusive inflammatory microangiopathy with extensive retinal damage by ischemia and a torpid clinical course despite suspension of treatment. These varieties of occlusive vascular events have not yet been found simultaneously in the literature and neither with an unfavorable clinical course. Although the clinical course of INF-associated retinopathy in most cases is asymptomatic, there may be complications with risk to vision, which is less common. The magnitude and severity of the consequences associated with INF therapy are to be determined in prospective further studies.

No MeSH data available.


Related in: MedlinePlus

Fluorescein angiogram 24.0 seg, 3:53 and 8:32. Fluorescein angiography shows delayed arterial and venous filling, large areas of ischemia in the superior quadrants, retinal hemorrhages, periphlebitis, macular edema, upper trunk venous occlusion and lower trunk venous stasis associated with occlusion of the superior temporal arterial branch.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC3037983&req=5

Figure 1: Fluorescein angiogram 24.0 seg, 3:53 and 8:32. Fluorescein angiography shows delayed arterial and venous filling, large areas of ischemia in the superior quadrants, retinal hemorrhages, periphlebitis, macular edema, upper trunk venous occlusion and lower trunk venous stasis associated with occlusion of the superior temporal arterial branch.

Mentions: A 45-year-old female, treated for 4 months with peg-INF a2a (180 μg weekly) and ribavirin (1,000 mg daily) for hepatitis C and diagnosed 1 year previously, presented with sudden painless visual loss in the left eye. Her general health did not show any other alterations. The presence of diabetes, hypertension and other risk factors (cardiovascular or systemic) was ruled out by an Internal Medicine doctor. Ocular examination showed visual acuity of 20/20 in the right eye and counting fingers in the left eye. The anterior segment did not show any alteration. Intraocular pressure in the right eye was 13 and in the left eye 8. Fundoscopy in the right eye was normal. The left eye revealed retinal vessel tortuosity, multiple flame hemorrhages at the posterior pole, cotton wool spots and superior temporal retinal pallor. Fluorescein angiography revealed delayed arterial and venous filling, large areas of ischemia in the superior quadrants, retinal hemorrhages, periphlebitis, macular edema, upper trunk venous occlusion and lower trunk venous stasis associated with occlusion of the superior temporal arterial branch (fig. 1). Optical coherence tomography (OCT) showed macular thickening (626 μm) secondary to diffuse edema and presence of microcysts (fig. 2).


Mixed vascular occlusion in a patient with interferon-associated retinopathy.

Bajaire BJ, Paipilla DF, Arrieta CE, Oudovitchenko E - Case Rep Ophthalmol (2011)

Fluorescein angiogram 24.0 seg, 3:53 and 8:32. Fluorescein angiography shows delayed arterial and venous filling, large areas of ischemia in the superior quadrants, retinal hemorrhages, periphlebitis, macular edema, upper trunk venous occlusion and lower trunk venous stasis associated with occlusion of the superior temporal arterial branch.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3037983&req=5

Figure 1: Fluorescein angiogram 24.0 seg, 3:53 and 8:32. Fluorescein angiography shows delayed arterial and venous filling, large areas of ischemia in the superior quadrants, retinal hemorrhages, periphlebitis, macular edema, upper trunk venous occlusion and lower trunk venous stasis associated with occlusion of the superior temporal arterial branch.
Mentions: A 45-year-old female, treated for 4 months with peg-INF a2a (180 μg weekly) and ribavirin (1,000 mg daily) for hepatitis C and diagnosed 1 year previously, presented with sudden painless visual loss in the left eye. Her general health did not show any other alterations. The presence of diabetes, hypertension and other risk factors (cardiovascular or systemic) was ruled out by an Internal Medicine doctor. Ocular examination showed visual acuity of 20/20 in the right eye and counting fingers in the left eye. The anterior segment did not show any alteration. Intraocular pressure in the right eye was 13 and in the left eye 8. Fundoscopy in the right eye was normal. The left eye revealed retinal vessel tortuosity, multiple flame hemorrhages at the posterior pole, cotton wool spots and superior temporal retinal pallor. Fluorescein angiography revealed delayed arterial and venous filling, large areas of ischemia in the superior quadrants, retinal hemorrhages, periphlebitis, macular edema, upper trunk venous occlusion and lower trunk venous stasis associated with occlusion of the superior temporal arterial branch (fig. 1). Optical coherence tomography (OCT) showed macular thickening (626 μm) secondary to diffuse edema and presence of microcysts (fig. 2).

Bottom Line: Some case series suggest that in most cases the clinical course of the disease is benign, asymptomatic and without long-term consequences and therefore do not recommend any specific treatment; they only recommend the discontinuation of INF in patients with severe manifestations or risk factors such as hypertension or diabetes mellitus.These varieties of occlusive vascular events have not yet been found simultaneously in the literature and neither with an unfavorable clinical course.The magnitude and severity of the consequences associated with INF therapy are to be determined in prospective further studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Vitreous and Retina, San Martin University, Bogota, Colombia.

ABSTRACT
Interferon (INF)-associated retinopathy occurs in 15-64% of INF-treated patients, transforming this complication into a significant risk for visual impairment. This retinopathy has been described as an ocular complication with a variable clinical course, usually benign and asymptomatic. The most common findings are hemorrhages and cotton wool spots. Atypical ocular side effects include branch or central retinal artery occlusion, central retinal vein occlusion, anterior ischemic optic neuropathy, optic disc edema, neovascular glaucoma and vitreous hemorrhage. Some case series suggest that in most cases the clinical course of the disease is benign, asymptomatic and without long-term consequences and therefore do not recommend any specific treatment; they only recommend the discontinuation of INF in patients with severe manifestations or risk factors such as hypertension or diabetes mellitus. The case reported here presents an atypical manifestation of INF-associated retinopathy consisting of a mixed retinal vascular occlusion (arterial and venous), associated with severe occlusive inflammatory microangiopathy with extensive retinal damage by ischemia and a torpid clinical course despite suspension of treatment. These varieties of occlusive vascular events have not yet been found simultaneously in the literature and neither with an unfavorable clinical course. Although the clinical course of INF-associated retinopathy in most cases is asymptomatic, there may be complications with risk to vision, which is less common. The magnitude and severity of the consequences associated with INF therapy are to be determined in prospective further studies.

No MeSH data available.


Related in: MedlinePlus