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We report an unusual case of Leber's hereditary optic neuropathy (LHON) with recurrent episodes of visual disturbance. The patient, a 53-year-old male, was a heavy smoker and alcohol drinker. At the age of 38, he was diagnosed as having bilateral optic neuropathy. After corticosteroid therapy, visual function recovered. By the age of 40, this condition had recurred five times. At the age of 51, he demonstrated decreased visual acuity in both eyes and Goldmann perimetry revealed bilateral cecocentral scotoma. Both optic nerves had blurred margins, a hyperemic appearance, and microangiopathy. A peripheral blood specimen showed a point mutation in mitochondrial DNA at np1 1778, indicating LHON. The patient was hospitalized for corticosteroid (methylprednisolone) therapy to help him cease smoking and drinking alcohol. After this treatment, his visual acuity recovered. We speculate that the mechanism involved the ATP deficiency theory in which visual disturbance is caused by an ATP deficiency due to a gene defect. The induced stress caused by smoking and drinking diminished during hospitalization due to the cessation of these activities by the patient. [ABSTRACT FROM AUTHOR]

Objectives: Various side effects of interferon (IFN) therapy have been reported. In this study, we examined retinal change during IFN therapy. Methods: We performed ophthalmological examinations before, during, and after therapy on 63 patients with chronic hepatitis C who were receiving either natural IFN-α or recombinant IFN-α 2a or 2b. Results: No retinal lesion was detected before IFN therapy, but, during therapy, retinal abnormality or retinopathy developed in 36 (57.1%) of 63 patients, including retinal hemorrhage in 25 patients and cotton-wool spots in 28 patients. They were noted early in the course of IFN therapy, within the first 4 wk in 67% (24/36) and within 8 wk in 86% (31/36). The incidence was not influenced by the type of IFN but was higher among diabetic (11/12, 92%, p < 0.05) or hypertensive patients (4/5, 80%, not significant) than among patients without either diabetes or hypertension (24/49, 49%). There was no relation between the incidence of retinopathy and the level of ALT activity or white blood cell or platelet counts. However, retinopathy occurred in most patients receiving IFN therapy after white blood cell count and platelet count reached a nadir. The levels of LDL-cholesterol and the atherosclerotic index in patients with retinopathy were slightly higher than those in the patients without retinopathy. Conclusions: These results suggest that retinopathy often occurs in patients with chronic hepatitis C who are receiving IFN and that we should closely monitor patients for retinal complications during IFN therapy. [ABSTRACT FROM AUTHOR]