Isotretinoin-related post-surgical interface alterations during sun light exposure: A case report

IntroductionRefractive surgery, including procedures like photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK), is increasingly common and generally safe, offering favorable optical outcomes. However, patients' anamnesis often lacks significant clinical information, such as systemic treatments for acne, diabetes, and polycystic ovary syndrome. Isotretinoin, a systemic treatment for severe acne, is rarely associated with corneal abnormalities.Patient and Clinical FindingsThis case report presents a 26-year-old female who underwent PRK for her myopic refractive error in both eyes, without disclosing her systemic isotretinoin therapy.Diagnosis, Intervention, and OutcomesPost-surgery, she developed fine bilateral basal membrane irregularities and subepithelial interface alterations. Despite a change in topical therapy, subepithelial haze persisted but improved over time, achieving an uncorrected distance visual acuity of 20/20 in both eyes at 2.5 months from surgery.ConclusionsIsotretinoin can induce ocular surface changes, including corneal epithelial thickening and stromal thinning, dry eye symptoms, and conjunctival modifications. Concurrent UVB exposure during corneal healing can exacerbate these effects, causing metabolic activation, extracellular matrix production, and corneal thickening. This case report highlights the importance of deepened patient's anamnesis before refractive surgery and suggests further studies on the relative contraindication of perioperative isotretinoin.