Effect of accutane on CNV in ARMD

Accutane^R (isotretinoin) has antiangiogenic activity proven by animal experiments. A phase 2 clinical rial has been performed to evaluate the effect on choroidal neovascularization in human. Criteria for recruitment were active CNV in ARMD, no acute illnesses, normal liver and renal functions and normal triglycerides and cholesterol levels. Complete eye exam, stereo color photos, stereo fluorescein angiograms, physical examination and safety laboratory tests were done 1 week before treatment, and every 4 weeks after initial treatment and one month post-treatment. Accutane was given orally 1 mg/kg q.d. for 12 weeks. Seventeen eyes with CNV in 13 patients were studied. In the 9 fellow eyes, 6 showed dry ARMD, 3 demonstrated scars. At the end of 12 weeks, vision was improved in 8 eyes (42%). stable in 9 eyes (47%), and worse in 2 eyes. The size of the CNV was decreased in 1 eye (7%), stable in 10 eyes (58%), and increased in 6 eyes (35%). Of the 11 eyes with relatively good results, 7 CNVs (64%) continued fibrosis or scarring and 4 either increased in size or developed recurrent CNV at one month following treatment completion. Two of 6 eyes with dry ARMD developed CNV during the time of observation. Further study in a randomized controlled trial may be beneficial.