干扰素相关性眼病

Interferon associated ophthalmologic complications

干扰素具有抑制病毒复制、免疫调节及抗肿瘤等多种效应，目前各种类型的干扰素在临床上广泛用于多种疾病的治疗。干扰素相关性眼病是干扰素治疗过程中出现相对少见的一种副作用，临床表现形式多样，包括干扰素相关性视网膜病变、干扰素相关性视神经病变和非典型眼部病变。其中干扰素相关性视网膜病变最常见，眼底表现为视乳头旁或后极部视网膜散在点状白色棉絮斑和／或点片状出血，大部分患者无症状，可不予特殊处理，病变即可消失自愈。但少数干扰素相关性眼病较重的患者，如出现前部缺血性视神经病变、视网膜血管阻塞、黄斑水肿、Vogt-小柳-原田综合征等，患者可出现不可逆性视功能损害，此时应终止干扰素治疗，并积极给予相应的治疗措施，如全身糖皮质激素治疗、抗血管内皮成长因子药物玻璃体内注射以及眼底激光等。详细询问病史，及时发现高危因素如患有高血压病、糖尿病、糖尿病视网膜病变或有Vogt-小柳-原田综合征史等，定期眼底检查，有助于本病的早期诊治。

Interferon （IFN） has antiviral, antiproliferative and immunomodulating effects. The vari- ous types of interferon are widely used in the treatment of many diseases in clinic. Interferon-associated oph- thalmologic complication is a relatively rare side effect in the process of treatment, and has diverse clinical manifestations, which can mainly be divided into： interferon associated retinopathy, interferon associated op- tic neuropathy and atypical ocular side effects. Interferon associated retinopathy, the most common form, manifests as scattered white cotton wool spots and/or small retinal hemorrhages around the disc and through the posterior pole. Most of the patients are visually asymptomatic and do not require any treatment. These le- sions can resolve over time. But a minority of patients may develop serious interferon associated ophthalmo- logic complications, such as ischemic optic neuropathy, retinal vascular obstruction, macular edema, Vogt- Koyanagi-Harada disease. These patients often complain of visual damage which may lead to irreversible vis- ual impairment. For these cases, the IFN therapy must be terminated, and aggressive early interventions must be offered, such as systemic hormone treatment, intravitreal injection of anti-VEGF agents and retinal laser coagulation, etc. In order to avoid permanent visual impairment, the physicians or ophthalmologists should be highly aware of these diseases, and ask detailed questions about the systemic disease and the his- tory of any eye diseases, and pay attention to high-risk factors： hypertension, diabetes mellitus, diabetic ret- inopathy, or a history of Vogt-Koyanagi-Harada disease. For high risk patients, periodically eye examina- tions are necessary.