June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Niacin (nicotinic acid) may reduce the risk of iris neovascularization in CRVO, and may show reversibility of effect when discontinued.
Author Affiliations & Notes
  • Michael W Gaynon
    Ophthalmology, Palo Alto Medical Foundation, Palo Alto, California, United States
  • Ehsan Rahimy
    Ophthalmology, Palo Alto Medical Foundation, Palo Alto, California, United States
  • Yannis Mantas Paulus
    Ophthalmology, University of Michigan, Ann Arbor, Michigan, United States
  • Sam Mansour
    Ophthalmology, Virginia Retina, Warrenton, Virginia, United States
  • Janet L Alexander
    Ophthalmology, University of Maryland, Baltimore, Maryland, United States
  • Footnotes
    Commercial Relationships   Michael Gaynon, None; Ehsan Rahimy, None; Yannis Paulus, None; Sam Mansour, None; Janet Alexander, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 1549. doi:
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      Michael W Gaynon, Ehsan Rahimy, Yannis Mantas Paulus, Sam Mansour, Janet L Alexander; Niacin (nicotinic acid) may reduce the risk of iris neovascularization in CRVO, and may show reversibility of effect when discontinued.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1549.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Purpose: In a prospective study of 50 CRVO patients, we previously found that niacin, possibly acting as a vasodilator, was associated with improved visual acuity (VA) and central macular thickness (CMT) at one year compared to controls. We hypothesized that niacin may possibly enhance collateral vessel formation, and by dilating choroidal vessels, may possibly reduce outer retinal hypoxia, accounting for those findings. There also appeared to be a reduced risk of iris neovascularization (NVI ) and neovascular glaucoma (NVG), with six patients with ischemic CRVO developing mild mid-stromal NVI that spontaneously regressed while taking niacin. We now report the potential risk of worsening iris neovascularization after cessation of niacin treatment.

Methods : Methods: A prospective, non-randomized, unmasked interventional case series study was conducted to study the effects of niacin on 50 patients with CRVO at a single institution. Niacin (nicotinic acid) was given in a dose of 500mg PO TID. Outcome measures included visual acuity, the presence or absence of iris or retinal neovascularization or neovascular glaucoma on dilated fundus exam, and central macular thickness on OCT. The primary study endpoint was at one year, but many of the patients have now been followed for over 10 years. Some patients inadvertently or deliberately discontinued niacin, sometimes with reversibility of effect regarding vision and central macular thickness. We studied the effect of discontinuing niacin on iris neovascularization.

Results : Results: Six patients of the 50 (12%) developed iris neovascularization. Of these, only one patient discontinued niacin, 11 years after onset of the CRVO. This patient had preexisting severe NPDR in the eye that developed a profoundly ischemic CRVO. The fellow eye eventually had PDR, stable after PRP. Transient, minimal, indolent-appearing mid-stromal iris neovascularization appeared one year after onset of the CRVO, but soon disappeared, similar to that seen in the other five patients. Ten years later, the patient stopped niacin, and quickly developed florid NVI and neovascular glaucoma, requiring a tube shunt.

Conclusions : Conclusion: Niacin may possibly reduce the risk of neovascular glaucoma in eyes with ischemic CRVO, with or without additional vasculopathic risk factors. Discontinuing niacin may lead to late onset of neovascular glaucoma.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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