Between 1995 and 2003, 156 patients treated with standard or pegylated alpha-interferon, with or without ribavirin, had a regular ophthalmologic examination before and during treatment. No patient had signs of retinopathy before treatment. Cotton-wool spots were found in 31 patients and retinal hemorrhage in nine patients during treatment (24 % of patients). These lesions remained asymptomatic and disappeared in all patients. A previous history of arterial hypertension (RR 4.60, 95 % CI 1.95–10.85), age above 45 years (RR 2.80, 95 % CI 1.36–5.85), and use of pegylated alpha-interferon (RR 2.75, 95 % CI 1.41–5.38) were significantly associated with retinopathy. Neurovisual impairment was present in 31 patients (20 % ) before treatment and in 74 patients (47 % ) during treatment.
In conclusion, this study showed that signs of retinopathy and neurovisual impairment were common in patients receiving alpha-interferon therapy but were rarely symptomatic. It suggests that alpha-interferon may usually be continued in asymptomatic patients as long as there is careful fundoscopic examination.