Evaluation of retina and optic nerve head using optical coherence tomography angiography in patients with acne vulgaris receiving systemic isotretinoin

Purpose: To assess OCTA(Optical Coherence Tomography Angiography)-derived microvascular changes in the retina and peripapillary region during systemic isotretinoin therapy for acne vulgaris. Methods: This prospective study included 52 right eyes of 52 patients aged 18–40 years who initiated oral isotretinoin at 0.5–1.0 mg/kg/day. All participants underwent comprehensive ophthalmologic examinations. OCTA measurements of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), as well as radial peripapillary capillaries (RPCs), were recorded at baseline and at 1 and 3 months. Macular analyses included whole-image, foveal, parafoveal, and perifoveal hemifields and quadrants. Peripapillary analyses included inside-disc and peripapillary ring quadrants. In addition, foveal avascular zone (FAZ) area was documented. Results: SCP vessel density increased significantly in the superior hemifield (whole-image), the parafoveal region (including the inferior parafoveal quadrant), and the superior perifoveal quadrant (p < 0.05), with no significant change in other sectors (p > 0.05). DCP vessel density showed no significant differences at any time point (all p > 0.05). FAZ area remained unchanged (p > 0.05). In the peripapillary analysis, inside-disc RPC density increased significantly (p < 0.05), while other peripapillary ring quadrants were unchanged (p > 0.05). Conclusions: Short-term isotretinoin therapy was associated with increased SCP macular and inside-disc peripapillary vessel density on OCTA. OCTA is a noninvasive modality that can aid early detection and monitoring of microvascular changes during isotretinoin treatment; longer follow-up is warranted to determine clinical relevance. Keywords: Acne vulgaris, isotretinoin, retina, optic nerve head, optical coherence tomography angiography