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Janet D. Leath, Michael W. Gaynon, Sam Mansour; Oral Niacin Treatment Of Central And Hemi Retinal Vein Occlusions Based Upon Patient Risk Factors. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3601.
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The purpose of this study is to quantify patient outcomes after HRVO or CRVO treatment with oral niacin, compare these outcomes to the natural history of retinal vein occlusions, and to identify risk factors that might facilitate increased response to oral niacin therapy in treatment.
Eighty-three patients with clinical HRVO or CRVO were started on niacin 1500 mg given orally daily. Pre- and post- niacin outcomes were assessed including visual acuity, color fundus photography, intravenous fluorescin angiography, and optical coherence tomography (OCT). Treatment responses were compared among subgroups with vascular risk factors such as hypertension, hypercholesterolemia, diabetes, and smoking. Treatment response in patients with glaucoma and glaucoma suspects were compared to patients without glaucoma. Visual and OCT macular thickness outcome data was compared to natural history data. Subgroup analysis was conducted on all patients.
Treatment responses to oral niacin were quantified according to visual acuity and OCT central foveal thickness. Overall 80% of patients started on oral niacin either maintained good vision or had an improvment in visual acuity, comparing favorably to the literature on the natural history of RVO. On average patients achieved a 3.2 line improvement in visual acuity, and a 329 micron decrease in macular thickness on OCT. Patients without any vascular risk factors showed a 1 line improvement in vision, while patients with hypertension improved an average of 3.7 lines. OCT improvement was similiarly more significant among hypertensive patients. Patients with more than one risk factor improved more than patients with zero or one risk factor. Patients with multiple risk factors improved most significantly with the exception of diabetes.
Patients with HRVO and CRVO were found to have improved vision and macular thickness after treatment with niacin, with no adverse events attributed to niacin use. Patients with vascular risk factors showed the most dramatic response to treatment with oral niacin; however, all subgroups showed a favorable response when compared to the natural history of CRVO and BRVO. Oral niacin may provide a safe inexpensive treatment for HRVO and CRVO, particularly in patients with vascular risk factors.
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