Cystoid Macular Edema Induced by Low Doses of Nicotinic Acid

Abstract

Cystoid macular edema (CME) is a condition that involves the macula, causing painless vision loss. In this paper, we report a case of niacin-induced bilateral cystoid macular edema (CME) in a middle-age woman taking low dose of niacin (18 mg of nicotinic acid). Optical coherence tomography (OCT) showed retinal thickening and cystoid spaces in both eyes, whereas fluorescein angiography (FA; HRA 2, Heidelberg Engineering) revealed the absence of fluorescein leakage also in later phases. Four weeks after discontinuation of therapy there were a complete disappearance of macular edema at funduscopic examination and an improvement of visual acuity in both eyes. Furthermore OCT showed a normal retinal profile in both eyes. In our opinion considering the wide availability of niacin, medical monitoring and periodical examination should be considered during niacin administration. To our knowledge, this is the first report in the literature that described the very low-dose niacin-induced bilateral niacin maculopathy.

Effects of Dietary Niacin on Growth Performance, Serum Biochemistry, Antioxidant Ability of Liver, Intestinal Digestion, and Absorption in Juvenile Golden Pompano

“…Niacin is closely related to lipid metabolism, amino acid and protein metabolism in animals (Hansen et al, 2015, Luo et al, 2017. It has a positive effect on increasing high-density lipoprotein cholesterol (HDL-C) and decreasing triglycerides (TG) (Domanico et al, 2015, Le et al, 2015.…”

Loratadine-associated cystoid macular edema: A case report

“…Drug-induced CME can be caused by various drugs such as taxanes, 4 acitretin 5 , tamoxifen, 6 niacin 7 , interferon, fingolimod, 8 prostaglandin, epinephrine, and timolol among others. 9 However, systemic anti-histamines- or anti-histamine eye drops-induced CME has not yet been reported.…”

“…1 While for drug-induced CME, several papers have reported that CME was not observed to be associated with leakage on fluorescein angiography. 12 , 13 , 14 , 15 Therefore, the mechanisms of drug-induced CME may differ from those of microvascular occlusion or inflammatory disease. The characteristics of drug-induced CME 6 are: (1) often bilateral, (2) no leakage on fluorescence fundus angiography (FFA), (3) a larger cystic space in the outer rather than the inner layer of the retina on OCT scans, and (4) spontaneous resolution and improvement of visual acuity after discontinuation of the causative drug.…”

Drugs Causing Cystoid Macular Edema: Pathogenesis, Diagnosis, and Treatment

“…[15] Niasin-Nikotinik Asit Niasin (nikotinik asit) hiperkolesterolemi tedavisinde oral olarak kullanılan bir vitamin preparatıdır. [21] Plazma apolipoprotein A ve B seviyelerini düşürerek plazma HDL, LDL ve VLDL düzeylerini azaltmakta ve trigliserid sentezini baskılamaktadır. [22] Niasinin oküler yan etkilerinin doz bağımlı ve geri dönüşümlü olduğu, yüksek dozda niasin kullananlarda 1-36 ay sonra makulopati geliştiği bildirilmektedir.…”

“…[21] Plazma apolipoprotein A ve B seviyelerini düşürerek plazma HDL, LDL ve VLDL düzeylerini azaltmakta ve trigliserid sentezini baskılamaktadır. [22] Niasinin oküler yan etkilerinin doz bağımlı ve geri dönüşümlü olduğu, yüksek dozda niasin kullananlarda 1-36 ay sonra makulopati geliştiği bildirilmektedir. [21] Günde 1.5 gramın üzerinde niasin kullanan hastalarda KMÖ riskinin arttığı saptanmıştır.…”