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Research Letters |

Management of Fingolimod-Associated Macular Edema

Jeanie Chui, MBBS, PhD; Geoffrey K. Herkes, MBBS, PhD; Andrew Chang, MBBS, PhD
JAMA Ophthalmol. 2013;131(5):694-696. doi:10.1001/jamaophthalmol.2013.47.
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Fingolimod is the first orally active drug approved for the management of relapsing-remitting multiple sclerosis (MS).1 Its immunosuppressive action is related to downregulation of sphingosine 1–phosphate receptor 1 on lymphocytes, which inhibits their egress from lymphoid tissues.2 Macular edema (ME) is an infrequent adverse effect of fingolimod, usually occurring within 3 months of initiation of treatment and resolving on cessation of fingolimod.1 We report a case of ME in a patient with MS receiving fingolimod and its successful management by topical anti-inflammatory drugs.

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Figure 1. Optical coherence tomographic images showing cystoid macular edema initially affecting the right eye (OD) at week 0, which improved on treatment with topical dexamethasone and ketorolac tromethamine. At week 4, topical treatment was extended to the previously untreated left eye (OS), which had begun to display cystic changes. Macular edema improved after topical treatment was increased to every 2 hours at week 23. At week 35, 5 weeks after cessation of fingolimod use, macular edema had completely resolved.

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Figure 2. Fundus photographs (A) and fluorescein angiograms (B) of the right (OD) and left (OS) eyes 1 month after commencing topical treatment with anti-inflammatory drugs. Late-phase fluorescein leakage is observed in the left macula.

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