Acetazolamide therapy in a case of fingolimod-associated macular edema: early benefits and long-term limitations.
Fingolimod is a potent drug in relapsing forms of multiple sclerosis. Visual impairment due to fingolimod-associated macular edema (FAME) usually leads to discontinuation of fingolimod therapy.


METHODS
We report on a 24-year old woman with bilateral FAME.


RESULTS
We continued fingolimod and added oral acetazolamide, which led to recovery of visual acuity and regression of macular edema. However, fingolimod had to be discontinued when fluorescein angiography revealed an enlarged foveal avascular zone.


CONCLUSIONS
Oral acetazolamide might be a treatment option for FAME, while ischemic conversion may be limiting. Ophthalmologic assessments are mandatory for follow-up when fingolimod therapy is continued after onset of FAME.
Department of Ophthalmology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany. Electronic address: Katharina.Schroeder@med.uni-duesseldorf.de.
Katharina
K
Schröder
Department of Ophthalmology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany. Electronic address: David.Finis@med.uni-duesseldorf.de.
David
D
Finis
Department of Neurology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany. Electronic address: Jens.Harmel@med.uni-duesseldorf.de.
Jens
J
Harmel
Department of Neurology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany. Electronic address: Marius.Ringelstein@med.uni-duesseldorf.de.
Marius
M
Ringelstein
Department of Neurology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany. Electronic address: Hans-Peter.Hartung@med.uni-duesseldorf.de.
Hans-Peter
HP
Hartung
Department of Ophthalmology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany. Electronic address: Geerling@med.uni-duesseldorf.de.
Gerd
G
Geerling
Department of Neurology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany. Electronic address: orhan.aktas@med.uni-duesseldorf.de.
Orhan
O
Aktas
Department of Ophthalmology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany. Electronic address: Rainer.Guthoff@med.uni-duesseldorf.de.
Rainer
R
Guthoff
D000086:Acetazolamide / Q000008:administration & dosage*; D000284:Administration, Oral; D005260:Female; D000068876:Fingolimod Hydrochloride / Q000009:adverse effects* / Q000627:therapeutic use; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008269:Macular Edema / Q000139:chemically induced* / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D009902:Optic Neuritis / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D014792:Visual Acuity; D055815:Young Adult
D007166:Immunosuppressive Agents; D000068876:Fingolimod Hydrochloride; D000086:Acetazolamide
Acetazolamide; Fingolimod; Macular edema; Multiple sclerosis