Keratorefractive Surgery in Patients with Systemic Isotretinoin Exposure: A Propensity-Score–Matched Analysis of LASIK and PRK
Adir Sommer, Michael Mimouni, Dror Ben Ephraim Noyman, Waseem Nasser, Avinoam Shye Shahar, Margarita Safir, Tzahi Sela, Gur Munzer, Igor Kaiserman, Asaf FriehmannPurpose:
To determine whether documented preoperative systemic isotretinoin exposure affects LASIK and PRK outcomes and complications.
Setting:
Care Vision Laser Center, Tel Aviv, Israel.
Design:
Retrospective comparative cohort study.
Methods:
Consecutive primary myopic LASIK and PRK procedures (January 2013 to June 2024), excluding retreated and monovision eyes, were reviewed. Exposure was ascertained from clinical notes and a preoperative medication questionnaire; patients whose exposure began after surgery were excluded. Exposed patients were propensity-score matched 1:4 to controls on age, sex, year of surgery, and preoperative spherical equivalent (SEQ), cylinder, and central corneal thickness. Outcomes were uncorrected (UDVA) and corrected (CDVA) distance visual acuity, SEQ, efficacy and safety indices, and documented complications.
Results:
Fifty patients (95 eyes) had documented preoperative exposure (LASIK, 11 patients/19 eyes; PRK, 39/76), matched to 200 control patients (388 eyes). The cessation-to-surgery interval was quantifiable in 39 patients (median, 95 days); 11 were operated 2 to 12 days after documented active use. No preoperative, intraoperative, or postoperative parameter differed between groups. Postoperative UDVA was 20/20 in both groups after LASIK and 20/22 versus 20/21 after PRK (adjusted difference, 0.015 logMAR; 95% CI, −0.016 to 0.045; P=0.35). No exposed eye lost a line of CDVA, documented complications did not differ, and outcomes did not vary across cessation strata.
Conclusions:
Outcomes of LASIK and PRK were comparable between eyes with documented preoperative isotretinoin exposure and matched unexposed eyes across all cessation intervals observed, including surgery within days of documented use. These preliminary findings warrant prospective confirmation with ocular-surface endpoints.