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Francis DeCroos, Michael Dollin, Nikolas London, Lisa Maiale, Philip Storey, Jason Hsu, James Vander, Carl Regillo; Effects of low-dose isotretinoin on rates of recurrent retinal detachment secondary to proliferative vitreoretinopathy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2852.
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To evaluate the effect of low-dose oral isotretinoin on recurrent retinal detachment (RD) secondary to proliferative vitreoretinopathy (PVR).
This prospective, non-randomized, open label trial studied administration of 20 mg isotretinoin daily for 12 consecutive weeks to patients following RD repair. Patients were subdivided into 2 groups: (1) recurrent RD with PVR and (2) primary RD at high risk for recurrent PVR RD. Risk factors included pre-operative grade B or worse PVR, retinal break larger than 3 disk diameters, retinal detachment greater than 2 quadrants, retinal detachment longer than 1 month without intervention, and vitreous hemorrhage. Simultaneous to enrollment in the treatment arm, an age-matched and pathology-matched cohort was identified and treated by the same group of surgeons to serve as the control arm.
In the recurrent RD with PVR group, fifty-six patients received isotretinoin and 47 patients did not. With at least 3 months of follow-up, the surgical success rate with a single intervention was 70% in patients on isotretinoin versus 70% in the controls (Fisher Exact Test, two tailed p = 1.00). In the primary RD group at high risk for recurrent PVR RD group, fifty patients received isotretinoin and 57 patients did not. In this arm, the surgical success rate with a single intervention was 80% in patients on isotretinoin versus 56% in the controls (p = 0.0128). The side effects of the medication have been generally mild. However, one patient had a substantial sustained increase in transaminases.
In patients with recurrent RD secondary to PVR, low dose isotretinoin does not reduce rates of re-detachment. Low dose isotretinoin may reduce rates of secondary PVR detachment in patients with primary RD at high risk for developing recurrent PVR detachment.
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