Structural and Functional Assessment in Patients Treated with Systemic Isotretinoin Using Optical Coherence Tomography and Frequency-Doubling Technology Perimetry

Evaluation of optic nerve head in patients with small optic disc using oral isotretinoin

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.

Ocular manifestations of systemic isotretinoin in patients with acne: a systemic review and meta-analysis

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.

Cross-sectional assessment of the ellipsoid zone and the retinal pigment epithelium-Bruch membrane complex after systemic isotretinotin use

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.

Visual field mean deviation and relevant factors in 928 Chinese retinitis pigmentosa patients

AIM

To investigate the associations between demographic and clinical factors with the rate of visual field mean derivation (MD) decline in retinitis pigmentosa (RP) patients.

METHODS

Correlations of MDs with the visual acuity and retinal pigmentation were analyzed in 928 RP patients. MD decreasing rate in 10y and potential influences of gender, age, family history and retinal pigmentation on the rate were explored in 201 RP patients.

RESULTS

In the 928 patients, average MD and visual acuity were -14.44±8.61 dB and 0.79±0.35 respectively and when MD was lower than -9.18 dB the visual acuity would be below 1.0 (20/20). The average MD medium between eyes with or without retinal pigmentation was -14.82 dB. In 123 non-pigmented eyes, the average MD were lower than the medium but in 153 pigmented eyes it was higher than that. In the 201 patients, the average decreasing value of MD in 10 years' period was -8.01±3.66 dB and the value were correlated to retinal pigmentation but not to gender, age or RP family history.

CONCLUSION

The rate of MD decline in RP eyes is significantly related to retinal pigmentation. Our study demonstrates the quantitative rate of MD decline in RP patients and the value of MD could well reflect the severity of RP.