OPTIC TRACT NEUROPATHY COMPLICATING LOW-DOSE INTERFERON TREATMENT

Optic neuritis occurred in three of our patients receiving treatment w ith alpha interferon-2b (Intron-A; 3MU thrice weekly) for chronic hepa titis. The complication appeared within, 1, 98/2 and 10 months of trea tment, respectively. In all cases, blurred vision was the initial comp laint and subsequent electrophysiologic investigation confirmed the pr esence of optic tract neuropathy. The patients had no other neurologic signs. Computerized tomography and magnetic resonance image of the br ain were not remarkable. Psychiatric symptoms, in the form of an inter feron-associated depressive reaction, were present in two of them; in one case, it was severe enough to require immediate discontinuation of treatment. In two patients the visual symptoms resolved and the param eters of neurophysiologic testing returned to normal within 1 month af ter stopping interferon. In one case, however, residual optic tract im pairment associated with a unilateral central scotoma and a substantia l decrease of visual acuity was present 2 years later, despite a cours e of methylprednizolone. In this patient the interferon treatment was continued for 3 months despite the visual symptoms, and he later recei ved two additional interferon courses because of relapses of hepatitis . We conclude that clinically evident optic tract neuropathy may compl icate interferon administration. Candidates for interferon treatment m ay need routine examination of optic fields and visual evoked potentia ls, before and during administration of the drug to avoid possibly per manent visual sequelae. (C) Journal of Hepatology.