[A rare case of cystoid maculopathy]

Area of Science:

• Ophthalmology
• Clinical Pharmacology

Background:

• Cystoid macular edema (CME) is a condition characterized by fluid accumulation in the macula.
• While various causes exist, drug-induced maculopathy is less common and often reversible.

Observation:

• A 67-year-old female presented with a 5-year history of bilateral central scotomata.
• Ocular examination revealed normal visual acuity but abnormal foveal reflexes.
• Fluorescein angiography showed no leakage, but optical coherence tomography (OCT) confirmed cystoid spaces in the fovea.

Findings:

• The patient had a 30-year history of daily niacin supplementation (average 100mg).
• Discontinuation of niacin led to symptom resolution and OCT improvement over 7 months.
• This case highlights chronic, low-dose niacin as a cause of maculopathy with a slower recovery pattern.

Implications:

• Clinicians should consider niacin supplementation in patients with cystoid macular edema lacking late leakage on fluorescein angiography.
• This finding expands the spectrum of niacin maculopathy, emphasizing the need for thorough medication history.
• Early recognition and discontinuation of niacin may lead to visual recovery in affected individuals.