title: Fingolimod therapy and macular hemorrhage.
abstract: A 54-year-old woman with relapsing-remitting multiple sclerosis (MS) developed visual loss in her left eye due to a macular hemorrhage 11 months after starting fingolimod. Visual acuity was 20/80 in the left eye, with a dense retinal hemorrhage involving the fovea with adjacent hard exudate and macular thickening confirmed by spectral domain optical coherence tomography. Three months after stopping fingolimod, vision in the left eye improved to 20/30 with resolution of the macular hemorrhage and exudates. Fingolimod has been associated with macular edema, but prior to this report, the authors are unaware of it causing a macular hemorrhage in a MS patient. The authors speculate that the macular hemorrhage may be due to a disruption of cellular adhesions between vascular endothelial cells that maintain the inner blood-retinal barrier.
authors.affiliation: Departments of Ophthalmology (MTB, THM) and Medicine (Division of Neurology) (MTB), Duke Eye Center and Duke University Medical Center, Durham, North Carolina; and Raleigh Neurology Associates, PA (SMF), Raleigh, North Carolina.
authors.forename: M Tariq
authors.initials: MT
authors.lastname: Bhatti
authors.forename: S Mitchell
authors.initials: SM
authors.lastname: Freedman
authors.forename: Tamer H
authors.initials: TH
authors.lastname: Mahmoud
mesh_terms: D001766:Blindness / Q000209:etiology*; D005260:Female; D000068876:Fingolimod Hydrochloride; D005451:Fluorescein Angiography; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008266:Macula Lutea / Q000473:pathology*; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications; D011409:Propylene Glycols / Q000627:therapeutic use*; D013110:Sphingosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D041623:Tomography, Optical Coherence
chemical_list: D007166:Immunosuppressive Agents; D011409:Propylene Glycols; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine