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Small Case Series | Jan 2013

Cystoid Macular Edema Associated With Fingolimod Use for Multiple Sclerosis

Armin R. Afshar, MD, MBA; Joshua K. Fernandes, MD; Ravi D. Patel, MD; Susan M. Ksiazek, MD; Veeral S. Sheth, MD; Anthony T. Reder, MD; Seenu M. Hariprasad, MD

JAMA Ophthalmol. 2013;131(1):103-107. doi:10.1001/jamaophthalmol.2013.570.

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Fingolimod is the first oral drug approved by the US Food and Drug Administration for multiple sclerosis (MS). It is a sphingosine-1-phosphate–receptor modulator that prevents lymphocyte egress from lymph nodes and enhances astrocyte function.¹^- 2 In this retrospective case series, 4 eyes from 3 patients developed cystoid macular edema (CME) after initiating fingolimod therapy. The study was approved by the University of Chicago Institutional Review Board.

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Figure 1. Case 1. Spectral-domain optical coherence tomographic images of the left eye 1 week prior to starting fingolimod (A), 4 weeks after starting fingolimod (B), and 8 weeks after starting fingolimod, after 4 weeks of topical nepafenac and difluprednate (C). I indicates inferior; N, nasal; S, superior; and T, temporal.

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Figure 2. Case 2. Spectral-domain optical coherence tomographic images of the right eye 2 weeks prior to starting fingolimod (A), 4 weeks after starting fingolimod (B), and 4 weeks after discontinuing fingolimod (C), and spectral-domain optical coherence tomographic images of the left eye 2 weeks prior to starting fingolimod (D), 4 weeks after starting fingolimod (E), and 4 weeks after discontinuing fingolimod (F). I indicates inferior; N, nasal; S, superior; and T, temporal.

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Figure 3. Case 2. Fundus photographs (A) and fluorescein angiograms (B) of the right and left eyes 4 weeks after starting fingolimod.

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Figure 4. Case 3. Time-domain optical coherence tomographic images of the left eye 5 days prior to starting fingolimod (A) and 4 weeks after starting fingolimod (B), and spectral-domain optical coherence tomographic images of the left eye 4 weeks after discontinuing fingolimod (C) and 3 months after discontinuing fingolimod (D). I indicates inferior; N, nasal; S, superior; and T, temporal.

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CME

Accreditation Information

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit^TM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 Credit^TM.

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Afshar AR, Fernandes JK, Patel RD, et al. Cystoid Macular Edema Associated With Fingolimod Use for Multiple Sclerosis. JAMA Ophthalmol. 2013;131(1):103-107. doi:10.1001/jamaophthalmol.2013.570.

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