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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8057
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I underwent 48 weeks of Interferon and Ribavirin (Peg/Cop)

Customer Question

I underwent 48 weeks of Interferon and Ribavirin (Peg/Cop) treatment ended 6 weeks ago.
Interferon can cause retinal problems. I had to have a baseline fundus exam b4 I was allowed to start the medications. Every was completely normal.
The last week of tx I went to my Ophthalmologist who found 2 CWS OS, and OD was normal. Three weeks later the CWS gone and now there is a retinal hemorrhage OD, few week after that he found another Heme OD. Sould I be concerned? He was not concerned at all. I thought that was odd. I would like my Hepatologist to send me to a Retinal Special for an angiogram, just to have pictures for documentation. I have not noticed any vision changes and my blood pressure averages 120/88 but has gone up and down during the 48 weeks.
Any thoughts....?
Thank you,
Nan
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Rick replied 3 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

Retina is my sub-specialty. Do you know what type of heme your ophthalmologist found? Does flame hemorrhage or dot/blot heme sound familiar to you?

Customer :

Hmmmm....I'm not sure. But maybe flame sounds right.

Customer :

He said it's normal for htn patients......but my blood pressure is normal. My heart rate is high, but that's not the problem.

Customer :

Would you recommend an angiogram......? I know I'm not going blind but it's so odd for me. I've always had low B/P. FYI ...I'm being treated at UCSD.

Dr. Rick :

I have seen a number of patients referred to me with interferon-associated retinopathy.

Dr. Rick :

In these patient I do obtain a fluorescein angiogram to better evaluate for any capillary non-perfusion and associated leakage with retinal edema.

Dr. Rick :

In patients that show CWS and hemorrhages related to their interferon therapy, along with evidence of capillary non perfusion, microaneurysms and capillary dilation on angiography I recommend that the therapy be discontinued. I know this can be disappointing, especially if the therapy is helping your other symptoms however I have seen, and the literature has reported, a continued worsening of the retinopathy on treatment and, even on a few occasions, after the cessation of therapy. They most common retinal pathology that can lead to decreased vision is called Cystoid Macular Edema and it can be difficult to treat in this situation.

Customer :

One important detail.....since I am about 40 days post tx the Hepatologist is suggesting that my retinopathy is probably not Interferon related. I believes I should get pics taken but on my dime....UCSD Research Dept is required to manage tx related side effects. My participation does not end untill June.....6 months after I stopped Interferon. Well you imput had helped me affirm what I should.

Dr. Rick :

What other medical conditions do you have?

Dr. Rick :

Also, I have seen patients with interferon associated retinopathy as far as 2 months into treatment. I do not seen any reason that this would not be related to your treatment. I do, however, agree that consultation with a retina specialist is indicated at this point.

Customer :

Thank you very much and Merry Christmas! fyi....I was able to complete the 48 week tx only because my fundus was never checked while on the medications. They only did a baseline prior...to be sure everything was normal....and it was. I on my own decided to have an eye exam with my Dr. I've read that during tx it

Dr. Rick :

I am glad you decided to have it checked!

Dr. Rick :


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Dr. Rick :

I hope things work out well for you. Have a happy holiday season.

Customer :

common to have dilated eye exams, otherwise unless a patient loses vision they never know something was ever wrong.

Dr. Rick :

k

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8057
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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