Sistemik İzotretinoin Tedavisinin Oküler Yüzey ve Gözyaşı Bezlerine Etkisi
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Acne vulgaris is a chronic disease, that is frequently seen in clinical practice. Systemic isotretinoin (13-cis-retinoik acid) treatment is frequently used for the treatment of this disease and the ocular surface and meibomian glands are also significantly effected. In our study, we evaluated 20 patients who were referred to our clinic for indications of the initiation of systemic isotretinoin treatment by Hacettepe University Medical Faculty Dermatology Department and 20 age matched subjects which were evaluated before in our clinic, as control group who applied for routine ophthalmologic examination to us. The control group and the patient group were examined by the same physician. Tear break up time, Schirmer test with anesthesia, ocular staining with lissamine green and florescein, corneal sensitivity measurements with Cochet-Bonnet esthesiometry, Meibomian gland dysfunctional staging with ocular surface examination findings, upper and lower eyelid meiboscore measurements with meibography and evaluation of basal epithelial cells and subbasal nerve plexus of the cornea by in vivo confocal microscopy (IVCM) were evaluated. The patient group was evaluated before treatment and at the end of the first and third months of the treatment for these parameters. It was found that there was a statistically significant difference between control group and patient group before treatment with MGD stages, lower and upper lid meiboscores with higher values in the patient group (p<0.005 for each value). During the treatment period, there was a significant increase in meibomian gland dysfunction (MGD) stage and lower and upper lid meiboscores in the patient group. In addition, there was an increase in ocular surface staining with fluorescein and a shortening in tear break up time (p = 0.043 and p = 0.017, respectively). Our study suggests that both acne vulgaris and systemic isotretinoin which is used in the treatment of acne vulgaris, causes both anatomical and functional disability on the meibomian glands and this treatment brings out significant changes in a short time on ocular surface.