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Sekeryapan Gediz B, Kılınç Hekimsoy H, Aydogan M, Aydugan MT, Corak Eroglu F. Crystalline lens clarity in patients treated with isotretinoin. Clin Exp Optom 2024:1-5. [PMID: 38914426 DOI: 10.1080/08164622.2024.2371360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024] Open
Abstract
CLINICAL RELEVANCE Isotretinoin has been the best treatment option for moderate and severe acne vulgaris since the 1980s. Some studies have shown evidence of subclinical anterior segment involvement of the eye in patients treated with isotretinoin. BACKGROUND This study aimed to evaluate lens clarity with the densitometry software of Scheimpflug tomography in patients treated with isotretinoin and to compare with healthy control subjects. METHODS Thirty-seven acnepatients treated with isotretinoin who met the inclusion criteria (24 males and 13 females, mean age 22.94 ± 4.21 years) and 39 healthy control subjects were included in the study. Clinical characteristics of the isotretinoin and control subjects were recorded. Lens density was evaluated with the densitometry software of the Scheimpflug tomography device (PentacamHR, Oculus, Wetzlar, Germany). RESULTS There was no statistically significant difference between the groups in age, gender distribution, spherical equivalent, or anterior segment parameters measured by the Pentacam system (p > 0.05 for all). Lens density values in zones 2 and 3 were significantly higher in the isotretinoin group (p = 0.042, p < 0.001) and positively correlated with cumulative isotretinoin dose (zone 2: r = 0.384, p = 0.032; zone 3: r = 0.384, p = 0.005). CONCLUSION Zone 2 and zone 3 lens density are higher in patients treated with isotretinoin when compared to healthy controls.
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Affiliation(s)
| | - Hilal Kılınç Hekimsoy
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Mert Aydogan
- Dermatology Department, Harakani State Hospital, Kars, Türkiye
| | - Merve Temmuz Aydugan
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Türkiye
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Dehghani A, Kargar S, Faghihi G, Adibi N, Noorshargh P, Dehghani S, Pourazizi M, Abtahi-Naeini B. Systemic isotretinoin therapy and central macular and choroidal thicknesses in acne vulgaris: is there any association? Cutan Ocul Toxicol 2023; 42:174-178. [PMID: 37399081 DOI: 10.1080/15569527.2023.2227895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/29/2022] [Accepted: 06/16/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE To investigate the effect of oral isotretinoin therapy on central macular thickness (CMT) thickness and choroidal thickness (CT) using optical coherence tomography (OCT). METHODS CT and CMT thickness of 43 eyes were evaluated at baseline, the third, and sixth month of isotretinoin therapy by spectral-domain OCT. For assessment of CT, OCT measurements were obtained at the fovea with six additional measurements at adjacent locations (at 500-1000 µm temporal to the fovea and 500-1000 µm nasal to the fovea). RESULTS Forty-three eyes from 43 patients with acne vulgaris, including 33 females (76.7%), who had a mean age of 24.81 ± 6.60 years, completed the study. The mean CMT was 231.49 ± 19.52 at the baseline and significantly decreased to 229.0 ± 19.57 (p = 0.02) and 229.28 ± 18.83 after three and six months, respectively (p < 0.03). The change in the macular thicknesses measured at four quadrants and choroidal thicknesses were not statistically significant during the study (p > 0.05). CONCLUSION The result of our study demonstrated choroidal thickness change is not significant in patients with acne vulgaris after systemic isotretinoin therapy during six months of follow-up. The decreased CMT amount was 2.2 microns; even if statistically significant, this amount is clinically insignificant.
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Affiliation(s)
- Alireza Dehghani
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Science, Isfahan, Iran
| | - Saeed Kargar
- School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Gita Faghihi
- Skin Diseases and Leishmaniosis Research Center, Isfahan University of Medical Science, Isfahan, Iran
| | - Neda Adibi
- Skin Diseases and Leishmaniosis Research Center, Isfahan University of Medical Science, Isfahan, Iran
| | - Pegah Noorshargh
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Science, Isfahan, Iran
| | - Shakiba Dehghani
- Farabi Eye Hospital, Department of Ophthalmology, Tehran University of Medical Science, Tehran, Iran
| | - Mohsen Pourazizi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Science, Isfahan, Iran
| | - Bahareh Abtahi-Naeini
- Skin Diseases and Leishmaniosis Research Center, Isfahan University of Medical Science, Isfahan, Iran
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Ozdemir I, Bulut HM, Kocamış SI. Evaluation of optic nerve head in patients with small optic disc using oral isotretinoin. Photodiagnosis Photodyn Ther 2022; 40:103147. [PMID: 36216022 DOI: 10.1016/j.pdpdt.2022.103147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Isotretinoin has a number of neurological and ocular side effects, but its effect on the optic nerve has not been demonstrated. PURPOSE To investigate the effect of oral isotretinoin therapy on the peripapillary retinal nerve fibre layer thickness (RNFL) in patients with small optic disc area using optical coherence tomography (OCT). METHODS This retrospective study included 55 patients taking 40 mg/day oral isotretinoin. The patients were grouped according to optic disc area. Patients with small optic disc area were included in group 1 and the others in group 2. RNFL thickness was measured by spectral domain OCT before the treatment, at the third month of the treatment, and at the third month after treatment. RESULTS RNFL increased significantly in group1 in the third month of treatment compared to that before the treatment (P < 0.001); no significant change was observed in group 2 (P < 0.244). DISCUSSION Oral isotretinoin treatment may be effective in patients with small optic nerve head. The presence of a small optic disc may increase the risk of adverse effects such as decreased dark adaptation, reduced vision, headache, or photophobia. CONCLUSION Evaluating the optic disc size before initiation of oral isotretinoin treatment may assist in planning patient treatment.
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Affiliation(s)
- Ibrahim Ozdemir
- Department of Ophthalmology, Dünyagöz Hospital, Sakarya, Turkey.
| | - Hüseyin Murat Bulut
- Department of Dermatology, Ağrı Training and Research Hospital, Ağrı, Turkey.
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Elubous KA, Toubasi AA, Elubous A, Alryalat SA, Abous H. Ocular manifestations of systemic isotretinoin in patients with acne: a systemic review and meta-analysis. Cutan Ocul Toxicol 2022; 41:113-122. [PMID: 35296199 DOI: 10.1080/15569527.2022.2050747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To examine the effects of systemic isotretinoin treatment on the eye using several ocular examination parameters. METHODS We conducted a systemic review for literature published up to June 2021 in both PubMed and Web of Science databases. We included prospective observational or interventional studies evaluating ocular manifestations of isotretinoin in acne patients. The primary outcome measures were anaesthetized and non-anaesthetized Schirmer test, tear break-up time (TBUT), central corneal thickness (CCT), average retinal nerve fibre layer (RNFL) thickness, ganglion cell-inner plexiform layer (GC-IP) thickness, subfoveal choroidal thickness, axial length, ocular surface disease index (OSDI), meibomian gland expression (MGE) and conjunctival stain. The National Institute of Health (NIH) quality assessment tools were used to assess the data quality. The effect size used to analyse the included studies was the weighted mean difference (WMD) and its related confidence intervals (95%CIs). RESULTS Twenty-one publications involving 1105 eyes of 842 participants met the inclusion criteria. Isotretinoin use was significantly associated with reduction in the scores of anaesthetized Schirmer (WMD = -2.23, 95%CI: -3.28 to -1.18), non-anaesthetized Schirmer (WMD = -3.74, 95%CI: -4.23 to -3.25), TBUT (WMD = -3.47, 95%CI: -5.09 to -1.86), and CCT (WMD= -7.39, 95%CI: -13.91 to -0.88). Isotretinoin use was significantly associated with increase of OSDI (WMD = 18.29, 95%CI: 7.54-29.03), MGE (WMD = 1.02, 95%CI: 0.70-1.33) and conjunctival stain scores (WMD = 0.61, 95%CI: 0.47-0.76). No significant change was noted in RNFL thickness (WMD = -0.64, 95%CI: -1.80 to 0.51); GC-IP thickness (WMD = 0.42, 95%CI: -1.08 to 1.92); subfoveal choroidal thickness (WMD = -1.80, 95%CI: -6.69 to 3.09), and axial length (WMD = 0.08, 95%CI: -0.19 to 0.35). A significant heterogeneity was found between the study estimates in each of anaesthetized Schirmer, TBUT, MGE, OSDI, and conjunctival stain tests. CONCLUSION Isotretinoin use results in a statistically significant reduction of the central corneal thickness, TBUT, and Schirmer test scores. A statistically significant increase in MGE, OSDI and conjunctival stain scores was found. No statistically significant change of average RNFL, GC-IP thickness, subfoveal choroidal thickness, or axial length was observed. Further well-designed studies should evaluate the long-term effect of isotretinoin on the eye and reach a firmer conclusion.
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Affiliation(s)
| | | | | | | | - Hebah Abous
- Department of Dermatology, Jordanian Royal Medical Services, Amman, Jordan
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Genç Işık İ, Işık MU. Cross-sectional assessment of the ellipsoid zone and the retinal pigment epithelium-Bruch membrane complex after systemic isotretinotin use. Cutan Ocul Toxicol 2022; 41:67-72. [PMID: 34979840 DOI: 10.1080/15569527.2021.2025386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the cross-sectional areas of the retinal pigment epithelium-Bruch membrane complex (RPE-B) and ellipsoid zon (EZ) and the thickness of the macula, retinal nerve fibre layer (RNFL), and ganglion cell-inner plexiform layer (GC-IPL) in patients using short-term systemic isotretinoin. METHOD A total of 43 right eyes of 43 patients treated with systemic isotretinoin for acne vulgaris were included in this prospective study. Macula, GC-IPL, RNFL thicknesses and central cross-sectional EZ and RPE-B areas were evaluated with optical coherence tomography (Zeiss, Cirrus HD OCT 5000) prior to treatment and in first, second and third months after the onset of isotretinoin treatment. For the measurement of EZ and RPE-B area, foveal EDI-OCT scans were binarized by using the public domain software ImageJ 1.51 s. RESULTS Mean duration of isotretinoin treatment was 77 ± 15 days and mean dose was 2228 ± 574 milligrams. There was a statistically significant increment in central cross-sectional EZ and RPE-B areas in each follow-up examination, when analysed by repeated measurement analysis (p:0.002 and p:0.006, respectively). There was no correlation between total isotretinoin dose and the difference between final and basal EZ and RPE-B areas (p > 0.05, for both). When repeated measurements in follow-up examinations were compared, GC-IPL thicknesses except the superotemporal region (p:0.040) and RNFL thicknesses did not show a significant difference (p > 0.05). There was not any significant relation between total isotretinoin dose and 3rd month and basal measurement differences in macula, GC-IPL and RNFL thicknesses in any area (p > 0.05, for all). CONCLUSION There has been an increase in the area of RPE-B and EZ with short-term use of isotretinoin therapy. Future studies examining the relationship between functional tests and the RPE-B and EZ areas may provide more in-depth information on the effects of isotretinoin in the eye.
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Affiliation(s)
- İrem Genç Işık
- Department of Dermatology, Kastamonu University Faculty of Medicine, Kastamonu, Turkey
| | - Mehmed Uğur Işık
- Department of Ophthalmology, Kastamonu University Faculty of Medicine, Kastamonu, Turkey
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Panigrahi PK. Comment on "Thinner temporal peripapillary retinal nerve fibre layer in Stargardt disease detected by optical coherence tomography". Graefes Arch Clin Exp Ophthalmol 2021; 259:3515. [PMID: 34219182 DOI: 10.1007/s00417-021-05300-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Pradeep Kumar Panigrahi
- Department of Ophthalmology, Institute of Medical Sciences & SUM Hospital, Sikshya O Anusandhan (Deemed To Be) University, 8-Kalinga Nagar, Bhubaneswar, 751003, India.
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Yasar E, Gurlevik U, Kemeriz F, Atalay E. Effect of isotretinoin on myopia and axial length: a pilot study. Cutan Ocul Toxicol 2020; 39:385-388. [PMID: 33054405 DOI: 10.1080/15569527.2020.1836649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the effect of oral isotretinoin use on refractive error, axial length, and anteroposterior segment parameters. MATERIALS AND METHODS In this prospective study, 50 eyes of 50 patients using isotretinoin with a diagnosis of acne vulgaris and 50 eyes of 50 healthy control subjects were included. After detailed biomicroscopy, measurements were taken of axial length, lens thickness, central corneal thickness, anterior chamber depth, central retinal thickness, and subfoveal choroidal thickness. The pupils of both eyes were dilated with one drop of cycloplegic drops after refraction measurement. Visual acuity examination was performed with a Snellen chart the next day. The same procedure was repeated at the end of the third and sixth month of drug treatment. RESULTS Forty-seven patients with acne vulgaris and 45 healthy controls met the inclusion criteria and were included in the analysis. The mean ages of the patients and the controls were 21.7 ± 2.5 years (range, 18-28 years) and 22.6 ± 2.7 years (range, 19-27 years), respectively. No significant changes were observed in any parameters in the third and sixth month in the control group (p > 0.05). The most important result was significant increases in myopia and axial length in the sixth month of isotretinoin use (p = 0.01, p = 0.04, respectively). There were no significant relationships between increases in myopia and axial length and patients' age, sex, drug dose, and initial refraction (p > 0.05). The changes in spherical equivalent and axial length differed significantly between the drug group and the control group (p = 0.001, p = 0.001, respectively). CONCLUSIONS Isotretinoin is one of the important molecules in the aetiology of myopia. Oral isotretinoin treatment may increase myopia and axial length, although not to a clinically significant degree. However, as this was a pilot study, there is a need for further studies with more patients and longer follow-up periods.
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Affiliation(s)
- Erdogan Yasar
- Department of Ophthalmology, Aksaray University Traininig ve Research Hospital, Aksaray, Turkey
| | - Ugur Gurlevik
- Department of Ophthalmology, Aksaray University Traininig ve Research Hospital, Aksaray, Turkey
| | - Funda Kemeriz
- Department of Dermatology, Aksaray University Traininig ve Research Hospital, Aksaray, Turkey
| | - Eray Atalay
- Department of Ophthalmology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
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Ruiz-Lozano RE, Hernández-Camarena JC, Garza-Garza LA, Bustamante-Arias A, Colorado-Zavala MF, Cardenas-de la Garza JA. Isotretinoin and the eye: A review for the dermatologist. Dermatol Ther 2020; 33:e14029. [PMID: 32683764 DOI: 10.1111/dth.14029] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/31/2022]
Abstract
Due to the prevalence of acne vulgaris, isotretinoin is one of the most prescribed drugs among physicians and dermatologists. Although exhibiting an adequate safety profile, adverse events secondary to isotretinoin use are common. Before prescribing isotretinoin, physicians usually inquire about pregnancy and perform serologic tests including cholesterol, triglycerides, and liver enzymes. Ocular manifestations are commonly neglected. Despite being generally mild, ocular manifestations related to either topical or systemic isotretinoin may cause important ocular morbidity. The ocular surface is the most affected site within the eye; however, retinal and optic nerve disease also have been documented. Evaporative dry eye disease, which may range from mild to severe, is the most common adverse ocular effect associated with isotretinoin use. The aim of this review is to present an up-to-date overview for the dermatologist about the prevention, diagnosis, and treatment of the ocular side effects of isotretinoin, and when to refer to the eye specialist.
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Affiliation(s)
- Raul E Ruiz-Lozano
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Julio C Hernández-Camarena
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Lucas A Garza-Garza
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Andres Bustamante-Arias
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Maria F Colorado-Zavala
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Jesus Alberto Cardenas-de la Garza
- Universidad Autónoma de Nuevo León, Rheumatology Service, University Hospital "Dr. José Eleuterio González", Monterrey, Nuevo León, Mexico
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Karadag O, Kocamaz M, Dastan M, Ozturk Durur S. Assessment of macular choroidal thickness, central macular thickness and retinal nerve fiber layer in patients receiving oral isotretinoin treatment. Cutan Ocul Toxicol 2020; 39:233-236. [DOI: 10.1080/15569527.2020.1778015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Onur Karadag
- Department of Ophthalmology, Darica Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Murat Kocamaz
- Department of Ophthalmology, Darica Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Metin Dastan
- Department of Ophthalmology, Darica Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Serap Ozturk Durur
- Department of Dermatology, Darica Farabi Training and Research Hospital, Kocaeli, Turkey
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Yavuz C, Ozcimen M. An evaluation of peripapillar choroidal thickness in patients receiving systemic isotretinoin treatment. Cutan Ocul Toxicol 2018; 38:25-28. [DOI: 10.1080/15569527.2018.1503289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Cahit Yavuz
- Department of Dermatology, Konya Training and Research Hospital, Konya, Turkey
| | - Muammer Ozcimen
- Department of Ophtalmology, Konya Training and Research Hospital, Konya, Turkey
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