Abstract
Purpose: :
This study examines the visual acuity of patients with central or hemiretinal vein occlusions treated with oral niacin. Macular thickness was also monitored using serial optical coherence tomography (OCT). Data is compared to two large multicenter studies, the Central Retinal Vein Occlusion Study (CVOS) and the Standard Care vs. Corticosteroid for Retinal Vein Occlusion (SCORE) Study.
Methods: :
Patients from two clinical practices with clinical and ophthalmoscopic characteristics of hemiretinal or central retinal vein occlusion were started on a regimen of immediate release niacin 1500 mg given orally. Patients were monitored at least monthly for visual acuity, color fundus photography, intravenous fluorescin angiography, and optical coherence tomography, and drug side effects.
Results: :
Patients with central or hemiretinal vein occlusion were studied. 26% of patients had an initial visual acuity of 20/40 or better, 52% were 20/50 to 20/200 and 22% were less than 20/200. In the CVOS natural history group, baseline visual acuities were 29%, 43%, and 28% respectively. After treatment with niacin, 88% of patients with initial visual acuities of 20/40 or better remained in this group. Of those with baseline visual acuity from 20/50 to 20/200, 37% improved, 63% remained in this range, and none became worse than 20/200 at the end of therapy. Of patients who began with vision worse than 20/200, 86% improved to better than 20/200, and 29% improved to better than 20/40. These outcomes compare favorably to the visual acuities documented in the CVOS. On average patients achieved a 3.2 line improvement in visual acuity. Patients had a 299 micron average decrease in peak macular thickness on OCT. Retinal thickness data is compared to observation and treatment data from the SCORE trial(Fig 1). Patients were also grouped according to risk factors and systemic conditions. Trends were identified in the patterns of subgroup response to niacin. No patients in the study had any serious side effects from oral niacin.
Conclusions: :
Patients with nonischemic HRVO and CRVO had improved vision and macular thickness after treatment with niacin, with no adverse events attributed to niacin use. Patients had similar characteristics and favorable outcomes compared to patients in the CVOS and SCORE study. These results are encouraging and a larger controlled study is warranted.
Keywords: vascular occlusion/vascular occlusive disease • anatomy