Retinal and orbital venous occlusions treated with enoxaparin

Retinal and orbital vein occlusions may cause a decrease in visual acuity. There is no known therapy to resolve ocular thrombosis. The authors used enoxaparin, a low-molecular-weight heparin, to treat 8 consecutive cases of retinal vein occlusions in 7 patients and 1 case of a superior orbital vein occlusion.

Four (4) central retinal vein occlusions in 3 patients, 4 branch retinal vein occlusions in 4 patients, and 1 superior orbital vein occlusion in 1 patient were treated with subcutaneous (SC) enoxaparin 100 IU/kg twice a day. The treatment lasted from 2 to 19 weeks. Eight (8) patients with retinal vein occlusions treated with ticlopidine were used as controls.

The 8 retinal vein occlusions opened up in all 7 patients with the absorption of the retinal edema and hemorrhage as soon as the occlusions were open. The orbital vein occlusion resolved with the absorption of the orbital edema. Visual acuity improved in 7 of the venous occlusions and was unchanged in 2. Visual acuity in the 8 controls improved in 4, was unchanged in 2, and was worse in 2.

Enoxaparin can be given SC twice a day in patients with retinal or orbital vein occlusions. The occlusions may take from 2 to 19 weeks to open up. Once the vein occlusions are open, the retinal edema, hemorrhage, and the orbital edema can rapidly absorb with visual improvement.