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Potentially Reversible Effect of Niacin Therapy on Edema From Retinal Vein Occlusion

Ehsan Rahimy, MD1; Michael W. Gaynon, MD1; Yannis M. Paulus, MD2,3; Janet L. Alexander, MD4,5; Sam E. Mansour, MD4,6
[+] Author Affiliations
1Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, California
2Kellogg Eye Center, University of Michigan at Ann Arbor
3Byers Eye Institute, Stanford University, Stanford, California
4Department of Ophthalmology, George Washington University, Washington, DC
5Department of Ophthalmology, University of Maryland, Baltimore
6Virginia Retina Center, Warrenton
JAMA Ophthalmol. 2016;134(7):839-840. doi:10.1001/jamaophthalmol.2016.1028.
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This case report describes a 63-year-old man with a history of hypertension, hyperlipidemia, and multiple strokes who presented with vision loss in the right eye, and after 1.5 years of persistent cystoid macular edema, he began a trial of niacin therapy.

An increasing body of evidence is supporting the role of nitric oxide (NO), a potent microcirculatory regulator, in the pathogenesis of ocular disorders. Within the posterior segment, NO is capable of dilating retinal and choroidal vessels down to the capillary level by relaxation of pericytes.1

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Figure.
Reversible Effect on Cystoid Macular Edema (CME) Secondary to Retinal Vein Occlusion After Stopping Niacin Therapy

Spectral-domain optical coherence tomography demonstrating persistent CME of 1.5 years’ duration (mean [SD] central macular thickness [CMT], 669.8 [79.3] μm) with visual acuity between 20/100 and 20/200 (A). Two weeks after starting niacin therapy (500-mg oral dose 3 times a day), CME improved (B) and, within 4 weeks, had resolved with visual improvement to 20/40 (C). The CME recurred after the patient reduced the dose to 500 mg once daily (D), resolving 2 weeks (E) and 6 weeks (F) after the patient resumed therapy with a 500-mg dose 3 times a day. Similarly, the CME quickly recurred after the patient stopped niacin therapy altogether (G) and predictably resolved after he restarted therapy (H), with visual recovery to 20/25.

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