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Determining the effect of low-dose isotretinoin on proliferative vitreoretinopathy: the DELIVER trial
  1. Nikolas J S London1,2,
  2. Richard S Kaiser1,
  3. Mohammed Ali Khan1,
  4. Rayan A Alshareef1,3,
  5. Mohammed Khuthaila1,
  6. Abtin Shahlaee1,4,
  7. Anthony Obeid1,
  8. Vanessa A London5,
  9. Francis Char DeCroos1,
  10. Omesh P Gupta1,
  11. Jason Hsu1,
  12. James F Vander1,
  13. Marc J Spirn1,
  14. Carl D Regillo1
  1. 1 The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
  2. 2 Retina Consultants San Diego, San Diego, California, USA
  3. 3 Department of Ophthalmology, King Abdulaziz University, Jeddah, Saudi Arabia
  4. 4 Department of Ophthalmology, University of California San Francisco, San Francisco, USA
  5. 5 Bernardo Dermatology, Poway, California, USA
  1. Correspondence to Dr Nikolas J S London, Retina Consultants San Diego, Poway, California 92064, USA; nik.london{at}gmail.com; Dr Richard S Kaiser, Mid Atlantic Retina, Philadelphia, Pennsylvania 19107, USA; richardskaisermd{at}gmail.com

Abstract

Purpose To examine the effect of low-dose, oral isotretinoin in lowering the risk of proliferative vitreoretinopathy (PVR) following rhegmatogenous retinal detachment (RRD) repair.

Methods Prospective, open label, dual-cohort study with pathology-matched historical controls. The prospective experimental arms included two cohorts, composed of 51 eyes with recurrent PVR-related RRD and 58 eyes with primary RRD associated with high-risk features for developing PVR. Eyes in the experimental arms received 20 mg of isotretinoin by mouth once daily for 12 weeks starting the day after surgical repair. The primary outcome measure was single surgery anatomical success rate at 3  months following the study surgery.

Results The single surgery anatomic success rate was 78.4% versus 70.0% (p=0.358) in eyes with recurrent PVR-related retinal detachment exposed to isotretinoin versus historical controls, respectively. In eyes with RRD at high risk for developing PVR, the single surgery success rate was 84.5% versus 61.1% (p=0.005) for eyes exposed to isotretinoin versus historical controls, respectively. For eyes enrolled in the experimental arms, the most common isotretinoin-related side effects were dry skin/mucus membranes in 106 patients (97.2%), abnormal sleep/dreams in 4 patients (3.7%) and fatigue in 3 patients (2.8%).

Conclusion The management and prevention of PVR is challenging and complex. At the dose and duration given in this study, oral istotretinoin may reduce the risk of PVR-associated recurrent retinal detachment in eyes with primary RRD at high risk of developing PVR.

  • accutane
  • epiretinal membrane
  • retinal detachment
  • scleral buckle
  • vitrectomy

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Footnotes

  • Contributors Case recruitment: NJSL, RSK, MAK, FCD, OPG, JH, JFV, MJS, CDR. Study design: RSK, NJSL, VAL. Funding application: NJSL. Data compilation: NJSL, MAK, RAA, MK, AS, AO, VAL, FCD. Data analysis: NJSL, RSK, RAA, AS, AO, VAL. Writing the manuscript: NJSL, RSK, MAK, AO, VAL, FCD, JH, JFV, CDR. Statistical advice: MAK, AS, AO.

  • Funding The authors would like to thank the J Arch McNamara Fund for Retina Research and the Wills Innovation Grant for financial support of this study.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional review board of Wills Eye Institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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