Journal of Ophthalmic Science
ISSN: 2470-0436
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Volume No: 1 Issue No: 4
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Research Article | Open Access
  • Available online freely | Peer Reviewed
  • Macular ganglion cell layer thickness in patients using oral isotretinoin

    Ozkan Kocamis 1       Ersoy Acer 2    

    1Ozkan Kocamis, Ahi Evran University, Medical School Ophthalmology Clinic, irsehir, Turkey

    2Ersoy Acer, Osmangazi University Medical School Dermatatology Clinic, Eskisehir, Turkey

    Abstract

    Objective:

    Determining the effects on macular ganglion cell layer thickness in patients using isotretinoin by utilization of optical coherence tomography.

    Material and Methods:

    Sixty eyes of 30 patients using isotretinoin and 60 eyes of 30 control group patients in the same age range were included in this study. The average age of the patients using isotretinoin was; 21.2 ± 3.62 years, whereas the average age of the patients in the control group was 22.7 ± 3.7 years. The thickness of the macular ganglion cell layer (GCL), the retinal nerve fiber layer (RNFL) and subfoveal macular thickness of all patients were measured with optical coherence tomography (OCT).

    Results:

    The macular ganglion cell layer thickness in the OCT of the patients using isotretinoin was measured as 61.6±4.6 µm, 62.4±4.4µm, for the right and left eye respectively, whereas the thickness in the control group was measured as 60.6±4.1µm, 61.2±4.9µm respectively. The retinal nerve fiber layer thickness in the OCT of the patients using isotretinoin was measured as 74.8±11.3µm, 76.2±12.3µm, for the right and left eye respectively, whereas the thickness in the control group was measured as 72.2±10.5µm, 74.1±1.9µm, respectively.

    Conclusions:

    No statistically significant difference was observed in the macular ganglion cell layer thickness, retinal nerve fiber layer thickness and macular thickness in terms of both the right and left eyes between the control group and patients using isotretinoin.

    Received 21 Jan 2017; Accepted 11 Apr 2017; Published 07 Jun 2017;

    Academic Editor:Federico Gonzalez-Fernandez, State University of New York Buffalo

    Checked for plagiarism: Yes

    Review by: Single-blind

    Copyright©  2017 Ozkan Kocamis, et al

    License
    Creative Commons License    This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Citation:

    Ozkan Kocamis, Ersoy Acer (2017) Macular ganglion cell layer thickness in patients using oral isotretinoin. Journal of Ophthalmic Science - 1(4):1-5.
    Download as RIS, BibTeX, Text (Include abstract )
    DOI10.14302/issn.2470-0436.jos-17-1442

    Introduction:

    Isotretinoin is a synthetic retinoid used for various dermatological diseases such as severe nodular cystic acne, acne vulgaris, stubborn psoriasis and is frequently used for various types of cancers.1 Isotretinoin has many known systemic and ocular side effects. The ocular side effects of isotretinoin are; meibomian gland atrophy, impaired meibomian gland secretion, blepharoconjunctivitis, dry eye, keratitis, myopia, decreased dark adaptation, decreased color vision, permanent dark adaptation, optic neuritis, diplopia, optic disc edema and intracranial hypertension.2, 3 Retinal ganglion cells contain melanopsin. Melanopsin is very similar to other opsin photopigments and is a retinaldehyde chromophore. Isotretinoin has an inhibiting effect on the chromophore regeneration of retinal ganglion cells.4 In this study, the effects on retinal ganglion cell layer thickness in patients using oral isotretinoin was investigated.

    Methods:

    This prospective study was performed Department of Ophthalmology, Faculty of Medicine, Ahi Evran University, Kirsehir, Turkey. Patients diagnosed with nodular acne,whom were using systemic isotretinoin (1mg/kg/day) were referred to the dermatology clinic. Informed consent forms were signed by all patients. Following the description of the Helsinki Declaration, the approval of the ethics committee was obtained. All patients underwent a complete ophthalmic examination, including best visual acuity and intraocular pressure measurements as well as biomicroscopy and fundoscopy examinations. Patients with over ± 3 diopters of refractive error, glaucoma, previous eye surgery, optic nerve diseases, macular disease and systemic diseases such as diabetes and hypertension were excluded from the study. The macular ganglion cell layer, retinal nerve fiber layer thickness, and subfoveal macular thickness were measured with Heildelberg OCT. The macular ganglion cell layer was measured at the thickest part of the macula, whereas the retinal nerve fiber layer thickness was measured from the temporal peripapillary area.

    Statistical Analysis:

    The statistical analysis were performed using the Statistical Package for the Social Sciences (SPSS) software version 23.0. The variables were investigated using visual (histograms, probability plots) and analytical methods (Kolmogorov-Smirnov / Shapiro-Wilk test) to determine whether or not they are normally distributed. Descriptive analysis was presented using means and standard deviations for normally distributed variables. The t-test was used to compare parameters betweenthe two groups. In cases where the age and the period of dru use beingnot normally distributed, the Mann-Whitney U test was used. While investigating the association between non-normally distributed variables, the correlation coefficients and their significance were calculated using the Spearman test. A p-value of less than 0.05 was considered to show a statistically significant result.

    Results:

    The mean duration of the isotretinoin treatment was 3.5±2.1 months. The average age of the patients using isotretinoin was; 21.2 ± 3.62 years, whereas the average age of the patients in the control group was 22.7 ± 3.7 years. Demographic data study group in Table 1. No statistically significant difference related to age was observed in the macular ganglion cell layer thickness in between the control group and the patients using isotretinoin in Table 2 (p>0.05). No statistically significant difference was observed in the thickness of the macular ganglion cell layer, the retinal nerve fiber layer and macular thickness of the left or right eye between the control group and the patients using isotretinoin(p>0.05).

    Table 1. Demographic data of the study group
      Isotretinoin Control
    Age(y) 21.2±3.62 22.7±3.7
    Gender (n)    
    (Woman/Man) 22/8 24/6
    uration(m) 3.5±2.1  

    Y: year, M: month
    Table 2. Evaluation of age, ganglion cell layer, retinal nerve fiber layer and macula layer between control group and isotretinoin group
            Isotretinoin Control Statistic 95% CI
    Mean±SD Mean±SD pvalue
    AGE*   21.2±3.62 22.7±3.7 0.079 0.072 0.083
    GCL**(µ) R 61.6±4.6 60.6±4.1 0.412 -1.326 3.193
      L 62.4±4.4 61.2±4.9 0.348 -1.264 3.531
    RNFL**(µ) R 74.8±11.3 72.2±10.5 0.348 -2.974 8.307
      L 76.2±12.3 74.1±10.9 0.487 -3.911 8.111
    MACL**(µ) R 218.3±22.1 213.7±13.4 0.334 -4.846 14.046
      L 216.6±20.7 215.2±11.6 0.736 -7.19 10.123

    * Mann-WhitneyU
    ** IndependentsamplesT Testi

    GCL: Ganglion cell layer. RNFL: Retinal nerve fiber layer. MACL: Macula layer. R: Right. L: Left µ: Micron

    In Table 3, no statistically significant difference was observed between the right or left eye regarding the thickness of the macular ganglion cell layer, the retinal nerve fiber layer and macular thickness in the group using isotretinoin (p>0.05). No statistically significant difference was observed between the right or left eye regarding the thickness of the macular ganglion cell layer, the retinal nerve fiber layer and macular thickness in the control group(p>0.05). In Table 4, a statistically significant, moderate degree, negative correlation related to age and the thickness of the ganglion cell layer of the left eye was observed in the group using isotretinoin(r=-0.483 p=0.007). No relationship related to the thickness of the macular ganglion cell layer of the right eye and the age was observed(p>0.05). No relationship related to the thickness of the retinal nerve fiber of the right and left eye and the age was observed(p>0.05). No statistically significant difference was observed between the duration of the isotretinoin administration and the thickness of the macular ganglion cell layer, the retinal nerve fiber layer and macular thickness of the right and left eye in the group using isotretinoin (p>0.05). A statistically significant, moderate degree, negative correlation related to age and the thickness of the ganglion cell layer of the right eye was observed in the control group (r=-0.52 p=0.003). No relationship related to the thickness of the macular ganglion cell layer of the left eye and the age was observed (p>0.05). No relationship related to the thickness of the retinal nerve fiber of the right and left eye and the age was observed(p>0.05).

    Table 3. Comparison of ganglion cell layer, retinal nerve fiber layer and macular layer thickness between control group and isotretinoin group for both eyes
    Groups     Statistic
     Eye P value 95% CI
    Isotretinoin  GCL R 0.493 -3.1 1.5
    L
     RNFL R 0.664 -7.4 4.8
    L
     MACL R 0.764 -9.4 12.7
    L
      Control    GCL R 0.609 -2.9 1.7
    L
     RNFL R 0.495 -7.4 3.6
    L
     MACL R 0.652 -7.9 5.0

    Independentsamples T Testi
    Table 4. Correlation between GCL, RNFL, MACL development with age and isotretinoin usage period
    * CORRELATION   Statistic    
    AGE EYE r p
    Isotretinoin  GCL R -0.034 0.86
      L -0.483 0.007
     RNFL R -0.299 0.108
      L -0.096 0.613
     MACL R 0.14 0.462
      L 0.171 0.365
      AGE
    Control  GCL R -0.52 0.003
      L 0.095 0.616
     RNFL R -0.079 0.678
      L -0.096 0.615
     MACL R 0.01 0.96
      L -0.078 0.682
      TIME
    Isotretinoin  GCL R -0.18 0.33
      L -0.35 0.055
     RNFL R 0.25 0.178
      L 0.19 0.309
     MACL R -0.18 0.33
      L -0.14 0.461

    * Spearman Testi

    Discussion:

    It is considered that retinoids play a vital role in the function, replacement,and growth of the nerve tissue. Electrophysiological and clinical findings indicate a causal relationship between central nervous system neurotoxicity or neuropathy acquired with oral retinoids.5, 6, 7 Decrease in visual acuity, various visual field defects, pseudotumor cerebri, optic neuritis and decreased color

    vision are the most common ocular nervous system side effects in patients receiving oral isotretinoin.3, 8 Central field of vision defects due to optic neuropathy and / or psodotumorcerebri are more common.9Several studies have reported the importance of determining the RNFL thickness for the management and early diagnosis of glaucoma, optic nerve diseases and optic nerve disorders containing optic neuritis. 10 OCT defines the changes in the RNFL thickness before the emergence of defects of the visual field.11Dinc et al 12 reported cases of decreased RNFL thickness and bilateral optical disc atrophy related to isotretinoin administration for the treatment of acne vulgaris. Ucak et al.13 reported the possible toxic effects of isotretinoinon RNFL, especially in the temporal layer. In the study conducted by Kapti et al.14 It is reported that isotretinoin has no effect on RNFL thickness We did not find a statistically significant difference in RNFL thickness in our study. Sari et al.9 investigated the optical nerve function, both clinically and in vision field test in patients treated with oral tretinoin and have not observed any differences in the same findings during 5.5 months. Sekeryapan et al. 15 did not find any difference in the thickness of GCL in patients using systemic isotretinoin in their study. We were unable to find any statistically significant difference in the GCL thickness in our study as well. Demirok et al.16found no significant effect on macular ganglion cell layer thickness in patients who used systemic isotretinoin for 1 year.

    As a result, even though oral isotretinoin has different ocular side effects, no effects related to the thickness of the retinal nerve fiber and the ganglion cell layer could be observed.

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