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Faraaz Ahmed Khan, Stephanie A Call, Vikram Brar, Puneet Singh Braich; Fingolimod associated Macular Edema: A Systematic Review. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3158.
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Fingolimod recently became the first oral agent to reduce relapses and delay progression in multiple sclerosis. However, macular edema is one of its adverse effects. The aim of this study was to perform a literature review and identify factors associated with successful outcomes in the management of fingolimod associated macular edema (FAME).
We performed a systematic literature search of MEDLINE, Embase and Cochrane databases. We identified 13 reports describing 20 eyes with FAME. We performed multiple independent 2-tailed t-tests to compare visual outcomes between patients who ceased fingolimod treatment once FAME was diagnosed vs. those who continued with fingolimod. We also compared visual outcomes between treated vs. untreated eyes. Further, we compared the time to resolution with treatment vs. without.<br />
FAME resulted in a mean loss of 3.43 lines of vision (P = 0.04) and a range of 0-8 lines lost. Fingolimod was stopped in 35% of eyes diagnosed with FAME, while 65% of eyes continued Fingolimod. The mean gain in vision for all eyes at final follow up was 2.18 lines (P = 0.04). At the conclusion of the study, 88% of eyes with FAME had a final VA that was within 1 line of their baseline VA regardless of how FAME was managed. There was no significant difference in vision gained between those stopping fingolimod and those who continued fingolimod (2.00 vs 2.25 lines, respectively. P = 0.83). Eyes with FAME managed by discontinuation of fingolimod without local therapy had a gain in vision similar to those eyes managed with topical nonsteroidal drugs and topical or periocular corticosteroids (2.2 lines vs 2.1 lines respectively, P =0.94). However the mean time to resolution of FAME was quicker in the group receiving treatment with local non-steroidal and corticosteroid therapy compared to those without local therapy (6.5 weeks vs. 9.2 weeks, P = 0.04). The resolution was even faster in those eyes receiving sub-Tenon’s triamcinolone or intravitreal triamcinolone (1 week). Prior uveitis, diabetes mellitus and bilateral disease were not significant factors in visual outcome (P <0.05).
The majority of FAME cases resolved within 1 line of the patient’s baseline vision regardless of management. The addition of local therapy may not result in improved visual outcomes but may hasten the resolution of FAME. Further reports are needed to identify risks and provide meaningful recommendations for treatment. <br />
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