title: Fingolimod Associated Bilateral Cystoid Macular Edema-Wait and See?
abstract: Fingolimod 0.5-mg once-daily is an approved therapy for patients with relapsing-remitting multiple sclerosis (MS). Several pivotal and real-world studies have demonstrated that fingolimod is associated with the development of macular edema (ME). Herein, we present a case of a diabetic MS patient who developed severe bilateral ME during fingolimod treatment. By means of this case study we provide a detailed review about fingolimod associated macular edema (FAME), its current incidence with or without diabetes mellitus, and previous therapy attempts and outcomes in MS patients. Intravitreal administration of antibodies raised against vascular endothelial growth factor A (VEGF-A) has not yet been used in the management of FAME, however, the excellent therapeutic response in our patient may justify the use of anti-VEGF-A agents in combination with cessation of fingolimod to achieve fast resolution of FAME and to prevent visual deficits, particularly in bilateral FAME.
authors.affiliation: Department of Neurology, Hannover Medical School, 30625 Hannover, Germany. pul.refik@MH-Hannover.de.
authors.forename: Refik
authors.initials: R
authors.lastname: Pul
authors.affiliation: Department of Neurology, Hannover Medical School, 30625 Hannover, Germany. osmanovic.alma@mh-hannover.de.
authors.forename: Alma
authors.initials: A
authors.lastname: Osmanovic
authors.affiliation: Private Ophthalmology Office, 30851 Langenhagen, Germany. info@dr-holger-schmalstieg.de.
authors.forename: Holger
authors.initials: H
authors.lastname: Schmalstieg
authors.affiliation: Department of Ophthalmology, Hannover Medical School, 30625 Hannover, Germany. pielen.amelie@mh-hannover.de.
authors.forename: Amelie
authors.initials: A
authors.lastname: Pielen
authors.affiliation: Department of Neurology, Hannover Medical School, 30625 Hannover, Germany. pars.kaweh@mh-hannover.de.
authors.forename: Kaweh
authors.initials: K
authors.lastname: Pars
authors.affiliation: Department of Neurology, Hannover Medical School, 30625 Hannover, Germany. Schwenkenbecher.Philipp@MH-Hannover.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schwenkenbecher
authors.affiliation: Department of Neurology, Hannover Medical School, 30625 Hannover, Germany. suehs.kurt-wolfram@mh-hannover.de.
authors.forename: Kurt Wolfram
authors.initials: KW
authors.lastname: Sühs
authors.affiliation: Department of Neurology, Hannover Medical School, 30625 Hannover, Germany. yildiz.oezlem@mh-hannover.de.
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Yildiz
authors.affiliation: Department of Neurology, University of Duisburg-Essen, 45147 Essen, Germany. benedikt.frank@uk-essen.de.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Frank
authors.affiliation: Department of Neurology, Hannover Medical School, 30625 Hannover, Germany. Stangel.Martin@mh-hannover.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Stangel
authors.affiliation: Department of Neurology, Hannover Medical School, 30625 Hannover, Germany. skripuletz.thomas@mh-hannover.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Skripuletz
mesh_terms: D000328:Adult; D002986:Clinical Trials as Topic; D005260:Female; D000068876:Fingolimod Hydrochloride / Q000009:adverse effects* / Q000627:therapeutic use; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D008269:Macular Edema / Q000139:chemically induced* / Q000473:pathology; D009103:Multiple Sclerosis / Q000188:drug therapy; D041623:Tomography, Optical Coherence
chemical_list: D000068876:Fingolimod Hydrochloride
keywords: VEGF; diabetes mellitus; fingolimod; macular edema; multiple sclerosis