Effect of oral pentoxifylline on cystoid macular edema associated with central retinal vein occlusion

To determine whether oral pentoxifylline, a xanthine-derived hemorheologic agent, decreases cystoid macular edema (CME) and improves visual acuity in eyes with a perfused central retinal vein occlusion (CRVO).

Retrospective chart review of consecutive patients on pentoxifylline (400 mg po TID) for CRVO was performed. Inclusion criteria included CME, pentoxifylline use for at least 1 month, and a follow-up period of at least 4 months. Exclusion criteria included nonperfused or indeterminate CRVO, the presence of neovascularization, and previous or concurrent laser therapy or any other treatment for CRVO. Statistical analysis of collected data was performed.

Eleven patients were identified. All patients had a perfused CRVO. The mean best-corrected Early Treatment Diabetic Retinopathy Study visual acuity was 60 letters (Snellen equivalent 20/128) before the initiation of oral pentoxifylline. The mean time from onset of CRVO to start of pentoxifylline therapy was 5 months (range, 1-12 months). The mean duration of pentoxifylline use was 5.3 months (range, 2.5-10.2 months). The mean follow-up period was 8 months (range, 2.7-16.5 months). Cystoid macular edema had improved in 64% (7/11) of eyes at last follow-up as measured by biomicroscopy and optical coherence tomography. The visual acuity was not significantly changed at 62 letters (20/128 +2) (Student t-test, P = 0.7) at last follow-up. There were no significant side effects from pentoxifylline. One patient had mild gastrointestinal disturbance.

Pentoxifylline has a favorable adverse effect profile, and can reduce CME in eyes with CRVO. Visual acuity does not appear to change significantly. A larger, randomized, multiarmed clinical trial evaluating the effects of pentoxifylline as an adjunctive treatment modality may be of benefit since even a small positive effect in altering the natural history of CME related to CRVO may be of value for these patients.