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Fingolimod therapy and macular hemorrhage
M Tariq Bhatti1, S Mitchell Freedman, Tamer H Mahmoud
1Departments of Ophthalmology (MTB, THM) and Medicine (Division of Neurology) (MTB), Duke Eye Center and Duke University Medical Center, Durham, North Carolina; and Raleigh Neurology Associates, PA (SMF), Raleigh, North Carolina.
Summary
Fingolimod, a multiple sclerosis (MS) treatment, may cause macular hemorrhage, a rare complication. Stopping the drug led to vision improvement and hemorrhage resolution in a patient.
Area of Science:
- Ophthalmology
- Neurology
Background:
- Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
- Fingolimod is a sphingosine-1-phosphate receptor modulator used to treat relapsing-remitting MS.
Observation:
- A 54-year-old woman with relapsing-remitting MS experienced sudden visual loss in her left eye.
- Ocular examination revealed a macular hemorrhage involving the fovea, with hard exudates and macular thickening.
Findings:
- The patient developed the macular hemorrhage 11 months after initiating fingolimod therapy.
- Discontinuation of fingolimod resulted in significant visual acuity improvement and resolution of the retinal hemorrhage and macular edema within three months.
Implications:
- This case suggests a potential link between fingolimod and macular hemorrhage, a previously unreported adverse event in MS patients.
- The mechanism may involve fingolimod-induced disruption of the inner blood-retinal barrier's vascular endothelial cell adhesions.
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