Effect of oral niacin on central retinal vein occlusion.
OBJECTIVE
Niacin, a treatment for dyslipidemia, is known to induce vasodilation as a secondary effect. Previous instances of patients with chronic central retinal vein occlusion (CRVO) and cystoid macular edema (CME) have been observed to spontaneously improve when placed on systemic niacin for hypercholesterolemia. The purpose of this study was to evaluate the effects of niacin on CRVO and associated ocular complications.


METHODS
A prospective, single-center, non-randomized, interventional case series of niacin for CRVO was conducted. Best-correct visual acuity (BCVA), central macular thickness (CMT), and ocular complications were analyzed in 50 patients over 1 year. Eight patients were controls.


RESULTS
The mean initial logMAR BCVA was 0.915, and improved with niacin to 0.745 (P = 0.12), 0.665 (P = 0.02) and 0.658 (P = 0.03) after 3, 6, and 12 months of follow-up, respectively. At baseline, mean CMT was 678.9 μm, and improved to 478.1 μm (P = 0.001), 388.6 μm (P < 0.001), and 317.4 μm (P < 0.001) for the same time points. The control group had a mean initial logMAR BCVA of 1.023, which gradually deteriorated to 1.162 (P = 0.36) after 12 months, and baseline CMT of 700.0 μm at baseline, which gradually improved to 490.9 μm (P = 0.06) after 12 months. Panretinal photocoagulation for neovascularization was required in 5 patients (13.2%) receiving niacin and 3 (37.5%) controls.


CONCLUSIONS
These data suggest that niacin may be associated with functional and anatomic improvements in eyes with CRVO. Future investigations will help ascertain whether there is a role for niacin as an adjunct therapy to intravitreal injections in the management of CRVO.
Department of Ophthalmology, Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA, 94301, USA.
Michael W
MW
Gaynon
Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA.|Byers Eye Institute, Stanford University, Stanford, CA, USA.
Yannis M
YM
Paulus
Department of Ophthalmology, Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA, 94301, USA. erahimy@gmail.com.
Ehsan
E
Rahimy
Department of Ophthalmology, George Washington University, Washington, DC, USA.|Department of Ophthalmology, University of Maryland, Baltimore, MD, USA.
Janet L
JL
Alexander
Department of Ophthalmology, George Washington University, Washington, DC, USA.|Virginia Retina Center, Warrenton, VA, USA.
Sam E
SE
Mansour
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D008266:Macula Lutea / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000008:administration & dosage*; D011446:Prospective Studies; D012169:Retinal Vein / Q000187:drug effects / Q000473:pathology*; D012170:Retinal Vein Occlusion / Q000175:diagnosis / Q000188:drug therapy*; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage; D014792:Visual Acuity
D014665:Vasodilator Agents; D009525:Niacin
Central retinal vein occlusion; Macular edema; Niacin; Nitric oxide