Sistemik izotretinoin tedavisine bağlı oküler yüzey ve gözyaşı film tabakası değişiklikleri

Amaç: Akne vulgaris nedeni ile sistemik izotretinoin tedavisi alan hastalarda kuru göz belirtileri, oküler yüzey ve gözyaşı film tabakası değişiklikleri ve bunların ortaya çıkış sürelerini değerlendirmek. Gereç ve Yöntem: Nodülokistik akne tanısıyla sistemik izotretinoin tedavisi alması planlanan 40 hasta çalışmaya dahil edildi. Hastalar sistemik izotretinoin başlanmadan önce, tedavi süresince ayda bir ve tedavinin tamamlanmasından bir ay sonra göz hastalıkları uzmanı tarafından muayene edildi. Kuru göze ait subjektif şikâyetlerin değerlendirilmesi için OSDI (Ocular Surface Disease Index) anketi, gözyaşı fonksiyonlarının değerlendirilmesi için anestezili ve anestezisiz Schirmer testleri, gözyaşı kırılma zamanı (GKZ) testi, korneal ve konjonktival boyama değerlendirmeleri yapıldı. Bulgular: Tedavinin birinci ayında tedavi öncesi değerlere göre ortalama OSDI skorunun 7,74±6,01'den 25,98±10,60'a (p

Objective: To investigate dry eye symptoms, tear film abnormalities, ocular surface changes and periods of their development in patients treated with systemic isotretinoin for acne vulgaris. Material and Methods: Forty patients given systemic isotretinoin for nodulocyctic acne were included in the study. Patients were evaluated before the initiation of treatment, monthly during the treatment and one month after termination of the treatment. Ocular Surface Disease Index (OSDI) Questionnarie for subjective dry eye complaints, tear function tests including Schirmer tests with and without anesthesia and tear break up time (TBUT) test, corneal and conjunctival stainings to detect tear film abnormalities were evaluated. Results: At first month of the treatment mean OSDI score increased from 7.74±6.01 to 25.98±10.60 (p<0.01), mean Schirmer score without anesthesia decreased from 21.18±5.75 to 14.75±6.50 (p<0.01), mean Schirmer score with anesthesia decreased from 13.78±4.67 to 8.63±4.20 (p<0.01) and mean TBUT score decreased from 12.25±3.05 to 7.98±3.71 (p<0.01) compared to the pretreatment values. These findings continued throughout the treatment. Twenty two (55%) patients developed conjunctival hyperemia, 22(55%) patients developed lid margin telengiectasia and 10(25%) patients developed corneal punctate epitheliopathy one month after therapy. These symptoms and signs were seen to continue decreaseingly at one month control of termination of the therapy. Conclusion: Isotretinoin is a retinoic acid derivative used frequently in dermatology clinics. It has side effects in many systems as well as the eye. In our study dry eye complaints, ocular surface changes and tear function abnormalities commonly started within the first month. One month after termination of the treatment tear funtions did not not reach the pretreatment levels. We advise that patients given systemic isotretinoin should be consulted to an ophthalmologist. They should use artificial tears If dry eye complaints start and tear functions tests are abnormal until they return to normal levels.

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