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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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Kapała J, Lewandowska J, Placek W, Owczarczyk-Saczonek A. Adverse Events in Isotretinoin Therapy: A Single-Arm Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116463. [PMID: 35682048 PMCID: PMC9180136 DOI: 10.3390/ijerph19116463] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
Isotretinoin (ISO) is an oral prescription-only retinoid, well known for its acne-treating effect. However, it affects a substantial number of human cell types, causing a broad spectrum of adverse effects. The purpose of this study is to establish the isotretinoin therapy adverse events among human clinical trials and their prevalence. Two authors (J.K., J.L.) systematically performed the literature review and assessment from December 2021-February 2022. Three databases (PubMed, ClinicalTrials, and Cochrane Library) were searched using the following terms: "isotretinoin acne vulgaris" for published studies in English from 1980-2021. Finally, 25 randomized controlled clinical trials (RCTs) and five open-label clinical trials provided 3274 acne vulgaris suffering patients. Isotretinoin therapy affects almost all of the systems in the human body, causing numerous adverse events. However, they mainly concern mild mucocutaneous conditions (severe cases are rare) and represent individual responses to a drug. In addition, all adverse events are reversible and can be avoided by specific preparations.
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Affiliation(s)
- Jan Kapała
- Medical Faculty, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland;
- Correspondence:
| | - Julia Lewandowska
- Medical Faculty, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland;
| | - Waldemar Placek
- Department of Dermatology Sexually Transmitted Diseases and Clinical Immunology, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland; (W.P.); (A.O.-S.)
| | - Agnieszka Owczarczyk-Saczonek
- Department of Dermatology Sexually Transmitted Diseases and Clinical Immunology, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland; (W.P.); (A.O.-S.)
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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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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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Akyol N, Kalkisim A, Turk A, Kola M, Imamoglu HI. Evaluation of the effects on choroidal thickness of bimatoprost 0.03% versus a brinzolamide 1.0%/timolol maleate 0.5% fixed combination. Cutan Ocul Toxicol 2017; 36:397-403. [PMID: 28376651 DOI: 10.1080/15569527.2017.1315128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the effects of two different medical treatment options on choroidal thickness (CT) in cases of open-angle glaucoma (OAG). METHODS Sixty-seven eyes newly diagnosed with OAG and 52 healthy eyes constituting the control group were included in the study. Glaucomatous eyes were randomly divided into two subgroups; Group I was started on bimatoprost 0.03% and Group II on a brinzolamide 1.0%/timolol maleate 0.5% fixed combination (BTFC). Intraocular pressure (IOP), ocular pulse amplitude (OPA) and subfoveal CT measurements were performed in all eyes in the study before treatment and on weeks 2, 4 and 8 after treatment. RESULTS Mean initial IOP values in groups I and II and the control group were 25.5 ± 4.7, 25.1 ± 5.2 and 16.1 ± 2.9 mmHg, mean OPA values were 3.7 ± 1, 3.6 ± 1.4 and 2.4 ± 0.6 mmHg and mean CT values were 269.4 ± 83, 264.5 ± 84.4 and 320.1 ± 56.6 μm, respectively. Eight weeks after treatment, mean IOP values in Groups I and II and the control group were 18.3 ± 2.6, 18.1 ± 3.4 and 15.7 ± 2.9 mmHg, mean OPA values were 2.9 ± 1.2, 2.8 ± 1.5 and 2.3 ± 0.8 mmHg and mean CT values were 290.2 ± 87.3, 271.8 ± 82.5 and 319.3 ± 56.8 μm, respectively. No significant difference was determined in terms of the decrease in IOP and OPA obtained after treatment in Group I and Group II. However, a significant difference was observed between the two groups in terms of choroidal thickening after treatment. CONCLUSION The use of topical ocular hypotensive medication in eyes with OAG results in an increase in CT. This increase is relatively greater with bimatoprost 0.03% therapy compared to BTFC.
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Affiliation(s)
- Nurettin Akyol
- a Faculty of Medicine , Department of Ophthalmology, Karadeniz Technical University , Trabzon , Turkey
| | - Ahmet Kalkisim
- a Faculty of Medicine , Department of Ophthalmology, Karadeniz Technical University , Trabzon , Turkey
| | - Adem Turk
- a Faculty of Medicine , Department of Ophthalmology, Karadeniz Technical University , Trabzon , Turkey
| | - Mehmet Kola
- a Faculty of Medicine , Department of Ophthalmology, Karadeniz Technical University , Trabzon , Turkey
| | - Halil Ibrahim Imamoglu
- a Faculty of Medicine , Department of Ophthalmology, Karadeniz Technical University , Trabzon , Turkey
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Demirok G, Topalak Y, Gündüz Ö, Yildirim D, Kocamaz MF, Şengün A. The long-term effect of oral isotretinoin therapy on macula ganglion cell complex thickness. Cutan Ocul Toxicol 2017; 36:259-262. [DOI: 10.1080/15569527.2016.1265549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Gülizar Demirok
- Eye Department, Saglik Bakanligi Ankara Egitim ve Arastirma Hastanesi, Ankara, Turkey
| | - Yasemin Topalak
- Eye Department, Ufuk Universitesi Tip Fakultesi, Ankara, Turkey, and
| | - Özge Gündüz
- Dermatology Department, Ufuk Universitesi Tip Fakultesi, Ankara, Turkey
| | - Dilsun Yildirim
- Dermatology Department, Ufuk Universitesi Tip Fakultesi, Ankara, Turkey
| | | | - Ahmet Şengün
- Eye Department, Ufuk Universitesi Tip Fakultesi, Ankara, Turkey, and
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Yılmaz U, Küçük E, Koç Ç, Özköse A. Investigation of the effects of systemic isotretinoin treatment on retinal nerve fiber layer and macula. J DERMATOL TREAT 2016; 28:314-317. [DOI: 10.1080/09546634.2016.1254146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Uğur Yılmaz
- Ophthalmology Department, Nigde State Hospital, Niğde, Turkey
| | - Erkut Küçük
- Ophthalmology Department, Nigde State Hospital, Niğde, Turkey
| | - Çağdaş Koç
- Dermatology Department, Niğde State Hospital, Niğde, Turkey
| | - Ayşe Özköse
- Ophthalmology Department, Kayseri Training and Research Hospital, Kayseri, Turkey
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