Risk of retinal vein occlusions in patients treated with rofecoxib (vioxx).
OBJECTIVE
To present patients with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) after application of rofecoxib (Vioxx), a cyclo-oxygenase (COX) 2 inhibitor.


METHODS
Three patients with sudden decrease in their vision were referred for evaluation and possible treatment.


RESULTS
A 72-year-old female with rheumatoid arthritis was treated with rofecoxib. When the dosage was doubled to 50 mg daily, she noticed a sudden painless decrease of vision in her right eye. Her visual acuity (VA) was 20/400 OD and 20/20 OS. Biomicroscopy OD demonstrated a CRVO with tortuous retinal veins and numerous flecked hemorrhages in the midperiphery. A 68-year-old female with severe osteoporosis developed a BRVO with flame-shaped hemorrhages in the superior hemisphere OS 1 day after taking rofecoxib (25 mg) daily. A 47-year-old American male took Vioxx for 1 week to relieve hip pain and noticed temporarily decreased vision OD. A month later, he resumed taking Vioxx and noticed a progressive decline in his VA with persistent cloudiness. Ophthalmic examination revealed a CRVO in his right eye.


CONCLUSIONS
Although COX-2 inhibitors are safe in the majority of patients, under certain conditions they may induce prothrombotic effects. Few patients with predisposed thrombosis may be at risk for cardiovascular and ocular thrombotic events.
Meyer
Carsten H
CH
Department of Ophthalmology, Philipps University, Marburg, Germany. meyer_eye@yahoo.com
Schmidt
Jorg C
JC
Rodrigues
Eduardo B
EB
Mennel
Stefan
S
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007783:Lactones / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D012170:Retinal Vein Occlusion / Q000139:chemically induced* / Q000175:diagnosis; D012307:Risk Factors; D013450:Sulfones / Q000009:adverse effects* / Q000627:therapeutic use; D014786:Vision Disorders / Q000139:chemically induced
D016861:Cyclooxygenase Inhibitors; D007783:Lactones; D013450:Sulfones; C116926:rofecoxib