Risk of retinal vein occlusions in patients treated with rofecoxib (vioxx)

To present patients with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) after application of rofecoxib (Vioxx), a cyclo-oxygenase (COX) 2 inhibitor.

Three patients with sudden decrease in their vision were referred for evaluation and possible treatment.

A 72-year-old female with rheumatoid arthritis was treated with rofecoxib. When the dosage was doubled to 50 mg daily, she noticed a sudden painless decrease of vision in her right eye. Her visual acuity (VA) was 20/400 OD and 20/20 OS. Biomicroscopy OD demonstrated a CRVO with tortuous retinal veins and numerous flecked hemorrhages in the midperiphery. A 68-year-old female with severe osteoporosis developed a BRVO with flame-shaped hemorrhages in the superior hemisphere OS 1 day after taking rofecoxib (25 mg) daily. A 47-year-old American male took Vioxx for 1 week to relieve hip pain and noticed temporarily decreased vision OD. A month later, he resumed taking Vioxx and noticed a progressive decline in his VA with persistent cloudiness. Ophthalmic examination revealed a CRVO in his right eye.

Although COX-2 inhibitors are safe in the majority of patients, under certain conditions they may induce prothrombotic effects. Few patients with predisposed thrombosis may be at risk for cardiovascular and ocular thrombotic events.