Intraocular complications of IFN-α and ribavirin therapy in patients with chronic viral hepatitis C

Table 1 Main characteristics and course of HCV-infected patients with VKH-like disease

	Case 1	Case 2	Case 3
Age (yr)	43	51	42
Sex	F	F	M
HCV genotype liver biopsy (Metavir)1	3	1	1
	A1F2	A1F2	A3F1
Anti-HCV therapy	PEG-IFN α-2b + Ribavirin	PEG-IFN α-2b + Ribavirin	PEG-IFN α-2b + Ribavirin
Interval before first ocular manifestations2	4 mo	3 mo	4 mo
Ocular manifestations	-Visual acuity 20/200 OS	-Bilateral vision loss	-Bilateral vision loss
	-Macular edema and a bilateral serous retinal detachment.	-Bilateral uveitis, major papillar and retinal edema	-Episcleritis and bilateral uveitis
Retinal fluorescein angiography	Pin-points and bilateral serous retinal and pigmented epithelium detachments, suggestive of a Vogt-Koyanagi-Harada like [VKH] disease
Therapeutic management	-PEG-IFN and ribavirin disruption	-PEG-IFN and ribavirin disruption	-PEG-IFN and ribavirin disruption
	-Methylprednisolone IV and per os	- Methylprednisolone IV and per os	- Methylprednisolone IV and per os
Course	-Complete recovery under low dose steroids (< 10 mg/d)	-Low improvement of ocular lesions	-Partial improvement of ocular lesions
	-Steroids were stopped after one year of treatment without ocular relapse.	-Cortico-dependency > 25 mg/d	-Cortico-dependency > 25 mg/d
		-Failure of cyclosporine course	-Re-introduction of PEG-IFN and ribavirin 5 mo later3
		-Introduction of azathioprine	-Full recovery of ocular manifestations 10 mo after IFN was reintroduced

¹Metavir scoring system for the appraisal of HCV-related liver disease.

²Time or interval between introduction of the anti-HCV therapy and the first ocular manifestations.

³Forcase 3, PEG-IFN and ribavirin was re-introduced because of the high level of cortico-dependency and based upon the reported efficacy of IFN in some cases of severe and refractory uveitis[14].