Macular Edema Caused by Fingolimod in Multiple Sclerosis:

To report a case of severe macular edema following the taking of fingolimod in multiple sclerosis.Case Report: A 34-year-old woman with a long history of relapsing-remitting multiple sclerosis presented complaining of blurred vision in the left eye that started 1 week before the presentation. She had been taking fingolimod for 4 months. She was not diabetic and had no history of uveitis but reported an episode of retrobulbar optic neuritis in both eyes. The initial ophthalmic examination, which was performed 2 weeks before initiating fingolimod, revealed a best corrected visual acuity (BCVA) of 20/25 OU and no ocular abnormalities. Upon the recent presentation, BCVA was 20/25 OD and 20/70 OS and there was no afferent papillary defect. The examination of anterior segment and anterior vitreous was unremarkable. Retinal examination of the left eye revealed cystoid macular edema with no other inflammatory signs or vascular changes. The findings of spectral domain optical coherence tomography (SD-OCT) were compatible with macular edema and indicated that the central macular thickness (CMT) was 605 microns. Fingolimod was discontinued and sinarolac was started three times daily. After 6 weeks, BCVA was 20/25 OD and 20/30 OS. Macular edema was resolved clinically and SD-OCT exhibited a significant reduction in macular edema with a CMT of 277 microns. Fingolimod-associated macular edema is a benign complication of the drug used for multiple sclerosis and. This complication responds well to the drug discontinuation and topical non-steroidal anti-inflammatory administration.