Abstract
Background/Purpose
Medication-induced ocular toxicity is an important consideration in the differential diagnosis of unexplained visual disturbance. We present a case of visual disturbance after starting treatment with glecaprevir/pibrentasvir (Mavyret), a therapy for Hepatitis C virus approved by the FDA in 2017.
Methods
A 50-year-old male with no significant ocular history experienced bilateral visual disturbance, including visual field and acuity loss, shortly after initiating treatment with Mavyret for Hepatitis C. Examination of the anterior and posterior segments was unremarkable, and no abnormalities could be identified on multimodal imaging of the eye and brain, including MRI, SD-OCT, and fundus autofluorescence. Extensive testing for inflammatory, infectious, nutritional, and genetic etiologies for optic neuropathy and retinopathy was negative.
Results
Electrophysiology testing was pursued to narrow the broad differential diagnosis. Full-field electroretinography and multi-focal electroretinography detected deficiencies in the rod and cone visual pathways and attenuated electrophysiologic responses in the fovea. Pattern electroretinography and visually-evoked potentials demonstrated macula dysfunction. Taken together, electrophysiologic data suggested diffuse retinal dysfunction, which was most pronounced in the macula.
Conclusions
Given the temporal relationship between Mavyret administration and vision loss in our patient, and the absence of an underlying cause after extensive evaluation, we propose that Mavyret may be associated with a toxic occult retinopathy characterized by panretinal dysfunction without clinically apparent structural findings.
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Acknowledgements
We would like to thank our funding sources: the National Eye Institute P30EY001792 (University of Illinois at Chicago core support) and unrestricted funds from Research to Prevent Blindness awarded to the University of Illinois at Chicago. We also thank the Ophthalmic imaging staff at the Illinois Eye and Ear Infirmary for their expertise and assistance.
The patient has consented to the submission of the case report for submission to the journal.
Funding
Supported by National Eye Institute P30EY001792 (UIC core support); unrestricted funds from Research to Prevent Blindness to the University of Illinois at Chicago.
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Summary statement: A patient developed visual disturbance and central scotomas after treatment of Hepatitis C with glecaprevir/pibrentasvir, a 2017 FDA approved therapy. The fundus appeared benign on indirect ophthalmoscopy, SD-OCT, and fundus autofluorescence. A diagnosis of toxic occult retinopathy was made based on visual field defects, acuity loss, and electrophysiological abnormalities.
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Massengill, M.T., Park, J.C., McAnany, J.J. et al. Occult retinopathy following treatment of Hepatitis C with glecaprevir/pibrentasvir (Mavyret). Doc Ophthalmol 146, 191–197 (2023). https://doi.org/10.1007/s10633-023-09923-0
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DOI: https://doi.org/10.1007/s10633-023-09923-0