Título

COROIDOPATIA SEROSA CENTRAL ASSOCIADA A ISOTRETINOINA

Introdução

Introduction:purpose to report a case bilateral excessive subretinal fluid during the use of isotretinoin.

Métodos

Methods: A 17 years old male patient presented to our clinic with blurred vision both eyes 1 week ago. He had been using oral isotretinoin for the last 2 weeks, as prescribed by his dermatologist to treat acne vulgaris.On examination visual acuity was 20/40 in both eyes. His pupils were equal round and reactive with no afferent pupillary defect. Intraocular pressure was 15mmhg. Biomicroscopic examination revealed blepharitis and meibomitis.Dilated fundus examination revealed lobulated shallow serous retinal detachment temporal of the fóvea bilateral. On fundus fluorescein angiography, multiple hyper fluorescent spots were seen in the temporal of the fovea in the early phases. Late phase phase revealed persistent and increased hyper fluorescence and serous macular detachment. OCT demonstrated neurosensory retinal detachment with subretinal fluid both eyes. results: One month later, visual acuity increased to 20/20 and oct demonstrate totally recovered with no residual sub retinal fluid after the discontinuation of isotretinoin.

Resultados

We found only 2 cases described in the literature with suspicion of Serous retinal detachment secondary to the use of oral Isotretinoin. Both dysfunction of the RPE and vascular hypermeability can generate the accumulation of subretinal fluid, however hypermerbeality is the main reason for the increase in hydrostatic pressure on the RPE and causes disintegration of the RPE {1,2}. We know that corticosteroids influence the expression of adrenergic receptors, contributing to the effect of catecholamines {3}. We believe that isotretinoin can act just like corticosteroids, increasing the permeability of EPR, Bruch's layer and choriocapillaries. In the literature, several causes for the accumulation of serous retinal fluid have been reported as diabetic retinopathy, choroidal ischemic disorders such as hypertension, lupus erythematosus, choroidal tumors, corticosteroid usage and inflammatory disorders such as Harada’s disease {3,4}. However, no systemic or ocular disorders were found in the patient in question.

Conclusões

In conclusion, we present a patient with bilateral Serous detachment of retina that used oral isotretinoin. We believe that the accumulation of liquid was caused by isotretinoin, which increased choriocapillary and EPR permeability.

Palavras Chave

isotretinoina central serosa

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