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Letters |

Fingolimod-Associated Macular Edema: Resolution by Sub-Tenon Injection of Triamcinolone With Continued Fingolimod Use

Ashley Minuk, BSc; Michel J. Belliveau, MD; David R. P. Almeida, MD, PhD, MBA; Stephen J. Dorrepaal, MD, FRCSC; Jeffrey S. Gale, MD, FRCSC
JAMA Ophthalmol. 2013;131(6):802-804. doi:10.1001/jamaophthalmol.2013.2465.
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Fingolimod (Gilenya) is an oral immunosuppressant approved for the treatment of relapsing forms of multiple sclerosis. In clinical trials, macular edema (ME) was found to be a dose-dependent adverse effect, occurring in 0.4% to 1% of patients.1 Most cases develop within 3 to 4 months of initiation and improve or resolve with discontinuation of treatment.13 We describe a 58-year-old woman with bilateral fingolimod-associated ME (FAME) who was adamant that her medication be continued. We treated her successfully in both eyes with sub-Tenon triamcinolone acetonide injection without discontinuing fingolimod.

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Figure 1. Optical coherence tomographic images of the right (A) and left (B) eyes show cystoid macular edema. I indicates inferior; N, nasal; S, superior; and T, temporal. Intravenous fluorescein angiograms of the right (C) and left (D) eyes show bilateral foveal leakage in a petaloid pattern characteristic of cystoid macular edema.

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Figure 2. Optical coherence tomographic images of the right (A) and left (B) eyes show complete resolution of fingolimod-associated macular edema with sub-Tenon triamcinolone acetonide injection and continued use of fingolimod. I indicates inferior; N, nasal; S, superior; and T, temporal.

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