Comparison of Autologous Serum Versus Preservative Free Artificial Tear in Patients with Dry Eyes Due to Systemic Isotretinoin Therapy.

PURPOSE: To investigate dry eye development in the patients receiving systemic retinoic acid therapy and to compare effectiveness of Autologous Serum (AS) and preservative free artificial tear (PFAT) in the patients with dry eye disease. METHOD: This prospective, crossover, double blind study was conducted on patients who have dry eyes due to systemic isotretinoin treatment for different indications. Patients detected as having dry eye during systemic isotretinoin treatment were included to our study. At baseline, 1 and 2 month of study, detailed ocular examination, best corrected visual acuity measurement, intraocular pressure measurement, and Tear Break-up Time (TBUT) and Schirmer Test (ST) without topical anesthesia were performed. We compared the efficacy of AS and PFAT. To accomplish crossover after the first month, treatment given to each patient was switched to the other treatment. Statistical analysis was measured using SPSS version 20.0. p values of < 0.05 were considered as statistically significant. RESULT: At the end of the first month, there was a significant improvement for the TBUT test in both AS and PFAT groups compared to baseline (respectively p < 0.001, p < 0.001). TBUT was found to be significantly higher in the AS group compared to the PFAT group at the end of the first month (p < 0.001). At the end of the second month, TBUT was found to be significantly higher in the AS group compared to the PFAT group at the posttreatment time (p < 0.001). There was a significant OSDI score decreasing in both groups compared to that reported previously at the end of the first and second months (respectively p < 0.001, p < 0.001). OSDI score decreasing was more significant in the AS group compared to the PFAT group at both time points (respectively p < 0.001, p < 0.001). CONCLUSION: AS may be an effective alternative to PFAT in the treatment of dry eye developed during isotretinoin use.

Investigation of the effects of systemic isotretinoin treatment on retinal nerve fiber layer and macula.

PURPOSE: To investigate the effects of systemic isotretinoin therapy on retina by measuring retinal nerve fiber layer (RNFL) and macular thicknesses. METHOD: This prospective, cross-sectional study was conducted in patients prescribed systemic isotretinoin therapy. Seventy-two eyes of 36 patients were included in the study. The patients were followed during three months. Detailed ophthalmologic examination including anterior and posterior segment examination, best corrected visual acuity and intraocular pressure measurement, RNFL and macular thicknesses measurement by Spectral Domain Cirrus Optical Coherence Tomography Model 400 (Carl Zeiss Meditech, Jena, Germany) were performed at baseline, first, second and third months after the beginning of systemic isotretinoin therapy in ophthalmology clinic. RESULT: Thirty (83.3%) of the 36 patients were women and six (16.7%) of them were men. Mean age was 21.17 years. Mean RNFL thickness in the temporal quadrant at first, second, third months after beginning of treatment were found as significantly lower compared to baseline (p = .001). Mean macular thicknesses in superior outer, nasal outer and temporal outer quadrants at second and third months after beginning of treatment were found to be significantly lower compared to baseline and first month after beginning of treatment (p ≤ .001, .002 and .001, respectively). Macular thicknesses in superior inner quadrant at first, second and third months were found to be significantly lower than baseline values (p< .01). No significant difference was detected between groups in other quadrants (p> .05). CONCLUSION: The effect of oral isotretinoin therapy may cause regional thinning in RNFL and macula, directly visible part of central nervous system.

Investigation of the skin characteristics in patients with severe GH deficiency and the effects of 6 months of GH replacement therapy: a randomized placebo controlled study.

OBJECTIVE: The presence of GH receptor in human skin and its appendages suggests a direct effect of GH on skin characteristics. The skin is usually thin and dry in patients with GH deficiency (GHD). Sheehan's syndrome classically refers to postpartum hypopituitarism and GH is one of the earliest pituitary hormones lost. While severe GHD is a well-established feature of Sheehan's Syndrome, skin characteristics and the effects of GH replacement therapy (GHRT) have been investigated neither in Sheehan's syndrome nor in other disorders of GHD. The aim of this study was to investigate the skin characteristics, including the sebum content, hydration (skin capacitance), transepidermal water loss (TEWL), pH and skin temperature, and particularly the effects of 6 months of GHRT on these parameters in GH deficient patients with Sheehan's syndrome. PATIENTS AND DESIGN: Sixteen severely GH deficient women with Sheehan's syndrome (48.1 +/- 10.9 years), and 20 age and menopausal status similar women as control subjects were included. Ten patients received recombinant GH for 6 months (treatment group) and 6 patients received placebo (placebo group) during this period. Skin properties were measured at baseline and after 6 months of GHRT using noninvasive and well-established measuring methods. RESULTS: At baseline the skin capacitance was significantly decreased on the forehead and forearm, and sebum content was significantly decreased on forehead in patients with Sheehan's syndrome compared to control subjects (P < 0.05). In the treatment group there was a significant increase in sebum content on forehead after 6 months of GHRT compared to the baseline value (P < 0.05). However there were no significant changes in other parameters including sebum content on the forearm, TEWL, Ph, skin capacitance and temperature of both the forearm and forehead. In the placebo group there were no changes in any of the evaluated parameters after 6 months of treatment compared to baseline values. CONCLUSIONS: The present study clearly shows that the sebum content on the forehead and skin hydration of the forehead and forearm are significantly decreased in GH deficient patients with Sheehan's syndrome. However 6 months of GHRT significantly increased only the sebum content on the forehead. These data suggest that GH and/or IGF-I may have a modulatory role on several skin characteristics.