title: Severe early bilateral macular edema following fingolimod therapy.
abstract: We report a case of bilateral macular edema (ME) within 10 days of starting fingolimod 0.5mg therapy in a patient with Multiple Sclerosis (MS). The complication resolved without treatment as demonstrated by sequential Optical Coherence Tomography (OCT). Fingolimod is a sphingosine-1-phosphate receptor modulator that reduces lymphocyte presence in the CNS. In pivotal trials, ME, a known complication of fingolimod, typically occurred unilaterally with onset at approximately 3 months. A 60y/o AA female, diagnosed with MS in 1977, started oral fingolimod treatment on 05/31/2011. Baseline screening with OCT and ophthalmology evaluation showed no ME. On 06/10, she developed bilateral blurry vision and discontinued fingolimod. On 06/27, OCT revealed severe bilateral ME. Later OCT exams showed a progressive decrease in Central Foveal Thickness (CFT) and Macular Volume (MV), without specific treatment other than discontinuation of fingolimod. On 7/27, CFT, MV, and Visual Acuity (VA) were similar to baseline. This is the first reported case of bilateral, early onset ME following fingolimod treatment at the current FDA-approved dose of 0.5mg. Diabetes, a known risk factor for ME, may have contributed to her early, bilateral involvement. Our case provides further support for earlier OCT, in conjunction with ophthalmic examinations, for at-risk patients on fingolimod, and suggests that cessation of fingolimod may be associated with resolution of ME.
authors: Pritzker School of Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago Il, 60637, USA. Electronic address: ocoppes@uchicago.edu.
authors: Oscar Jim Michael
authors: OJ
authors: Coppes
authors: School of Medicine, Ross University, Commonwealth of Dominica, West Indies.
authors: Ismael
authors: I
authors: Gutierrez
authors: University of Chicago, Chicago, USA.
authors: Anthony T
authors: AT
authors: Reder
authors: University of Chicago, Chicago, USA.
authors: Susan
authors: S
authors: Ksiazek
authors: University of Chicago, Chicago, USA.
authors: Jacqueline
authors: J
authors: Bernard
keywords: Macular edema; Multiple sclerosis; Optic nerve; Optical coherence tomography; Retina; Vision loss