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M.W. Gaynon; High Dose Niacin as a Potential Vasodilator in the Treatment of Nonischemic Central and Hemiretinal Vein Occlusion . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4062.
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Purpose: To evaluate the effect of lipid lowering doses of niacin on the course of nonischemic central and hemiretinal vein occlusion. Methods: A prospective, nonrandomized pilot study of niacin as a possible vasodilator for venous occlusion was undertaken. Eight consecutive patients with worsening nonischemic central (6) or hemiretinal (2) vein occlusions were placed on lipid lowering doses of niacin (range 1-2 grams/day) under an internist’s supervision. They were followed with sequential examinations and fundus photos. Major outcome measures were changes in vision, vascular congestion, amount of hemorrhage and macular edema. Results: Over time, usually a few months, retinal hemorrhages subsided, as did vascular congestion and macular edema. Vision improved subjectively in the form of a sense of expanded field as hemorrhages resolved. This was followed in most eyes with improved Snellen acuity as macular edema subsided (Table). One patient, Case 3, stopped niacin in preparation for a bone marrow transplant for chronic myelogenous leukemia. Soon afterward vision dropped as vascular congestion and hemorrhages increased, suggesting reversibility of effect. Conclusion: Niacin was associated with clinical improvement in CRVO and HRVO, with progressive resolution of retinal hemorrhages, vascular congestion and macular edema. Most eyes showed improved visual acuity. The outcomes were comparable to those described for heroic surgical interventions, with far less risk and expense. Niacin may possibly induce vasodilation either directly or by means of a prostaglandin mediated release of nitric oxide, a potent vasodilator. This might buy time until collateral vessels have a chance to develop. Table View OriginalDownload SlideView OriginalDownload Slide
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