Bilateral fingolimod-associated macular oedema development after cataract surgery

Abstract

Postoperative cystoid macular oedema (CMO) is a recognised complication of cataract surgery, occurring in around 1.5% of cases. It is generally managed with topical steroids or non-steroidal anti-inflammatory medications. We present a case of a patient who developed bilateral sequential CMO following bilateral sequential cataract surgery which was non-responsive to topical therapy and worsened following sub-Tenons administration of steroid. The patient took fingolimod for multiple sclerosis both prior to and during the period of cataract surgery which is known to result in the development of macular oedema in some patients. On fingolimod cessation, the oedema resolved over a period of 5 months with good visual recovery. We present this case to inform cataract surgeons of the risk of fingolimod-associated macular oedema in patients undergoing cataract surgery and to inform neurologists of the potential need to adjust treatment for patients undergoing cataract surgery.

Diagnosis and Management of Fingolimod-Associated Macular Edema

“…Our study found that FAME occurred mainly 3 m after the initiation of fingolimod, consistent with the phase III MS study and their extensions (14). However, a small proportion of patients develop late-onset ME (more than 12 months) (6,15,24,30,35), and blurred vision has also been reported as early as 24 h after initiation of the 0.5 mg dose (29). Patients with ME with diabetes or previous uveitis appear to develop it earlier.…”

“…However, the optimal frequency of follow-up periodic re-evaluation has not been determined, but some researchers recommend regular eye exams after 6 months and then annually (35). Patients who had fingolimod therapy, and who are also undergoing ophthalmic surgery, such as cataract surgery, may be at increased risk of developing ME and may benefit from increased monitoring or preventive treatment for ME (10,15,22,34). Patients who have started fingolimod with a history of diabetes mellitus, uveitis, or concomitant medication associated with ME require closer monitoring.…”