Fingolimod-associated Macular Edema Research Articles

Fingolimod-Associated Macular Edema in the Treatment of Multiple Sclerosis.

Multiple sclerosis is a neurological disorder categorized by inflammatory processes with a high prevalence worldwide. It affects both motor and sensory pathways and is also associated with the visual pathway.Fingolimod is a commonly used drug for relapsing-remitting multiple sclerosis. It is a sphingosine 1-phosphate modulator acting on its receptors for immune cell accumulation, neuronal function, embryological development, vascular permeability, smooth muscle cell function, and endothelial barrier maintenance.This review aims to understand the processes, mechanisms, risks, and management of fingolimod-associated macular edema. Due to the anti-inflammatory properties of fingolimod, it decreases various cytokines, including interleukin (IL)-1B and IL-6, spike wave, and spike amplitude, in electrophysiological activities and decreases insoluble receptors for advanced glycation end productligand. A daily dosage of 0.5 mg of fingolimod has an increased association with macular edema. The serious adverse events of fingolimod are lymphopenia, cardiovascular events, ocular events, and carcinoma. Fingolimod decreases brain volume and increases vascular permeability, resulting in increased macular volume and damage to the blood-retinal barrier, which causes an increased risk for macular edema. Cystoid macular edema is more common in older individuals suffering from comorbidities affecting the retina, such as diabetes, or those undergoing ophthalmological surgeries. This review also highlights the importance of regular ophthalmology examinations on patients consuming fingolimod both in the initial stages and chronic use. The treatment options for macular edema include nonsteroidal anti-inflammatory drugs, acetazolamide, triamcinolone, ketorolac, corticosteroids, and intravitreal procedures.

Diagnosis and Management of Fingolimod-Associated Macular Edema.

ObjectiveTo investigate the clinical features, treatment, and prognosis of fingolimod-associated macular edema (FAME) and to provide a reference for its rational management.MethodsFAME-related case reports were included in a pooled analysis by searching Chinese and English databases from 2010 to November 31, 2021.ResultsThe median age of 41 patients was 50 years (range, 21, 67 years), of whom 32 were women. The median time to onset of FAME was 3 m (range.03, 120), and blurred vision (17 cases) and decreased vision (13 cases) were the most common complaints. A total of 55 eyes were involved in FAME, including the left eye (14 cases), right eye (10 cases), and both eyes (15 cases), of which 46 eyes had best-corrected visual acuity close to normal (20/12-20/60) and 8 eyes had moderate to severe visual impairment (20/80-20/500). Fundus examination in 23 patients showed macular edema (11 cases). Optical coherence tomography (OCT) in 39 patients mainly showed perifoveal cysts (24 cases), ME (23 cases), and foveal thickening (19 cases). Fundus fluorescein angiography (FFA) in 18 patients showed vascular leakage (11 cases). Complete resolution of ME occurred in 50 eyes and recovery of visual acuity occurred in 45 eyes at a median time of 2 m (range 0.25, 24) after discontinuation of fingolimod or administration of topical therapy.ConclusionsMacular edema is a known complication of fingolimod. All patients using fingolimod require regular eye exams, especially those with a history of diabetes and uveitis and those undergoing cataract surgery.

Fingolimod-associated macular edema: A case report of late onset

The authors present a case of a male with Multiple Sclerosis (MS) who developed unilateral Fingolimod-Associated Macular Edema (FAME) 10 years after initiating fingolimod therapy. By reporting this case study, the authors present a comprehensive review on FAME, its current incidence, and therapy options in MS patients. A 58-year-old Caucasian male patient was referred to the hospital with a history of MS. He was on fingolimod treatment for 10 years. The patient presented with a referring second episode of blurred vision in his left eye (OS). His best corrected visual acuity (BCVA) was 20/20 (right eye - OD) and 20/30 (OS). Dilated fundus examination of the OS revealed dull foveal reflex with retinal thickening. Spectral domain optical coherence tomography (SD-OCT) scan demonstrated increased central macular thickness of 459 μm, foveal cysts and subretinal fluid. Neurologists decided to discontinue fingolimod treatment based on the ophthalmological findings. Three months post fingolimod discontinuation, macular edema resolved and BCVA was 20/20 (OD) and 20/25 (OS). The authors report a case of late onset FAME. FAME may occur several years after starting fingolimod treatment and it should be part of differential diagnosis of blurred vision in patients receiving fingolimod. Both Microcystic Macular Edema secondary to MS and Macular Edema Associated with MS-induced Uveitis should always be excluded. Those two conditions, secondary to MS, might show the lack of drug effectiveness and the possible need for changing the existing therapy in order to prevent further disease progress.

FAME: A Resident's Reflection on a Tanzania Medical Trip

Residents' Review| March 2021 FAME: A Resident's Reflection on a Tanzania Medical Trip Margaret Chiu, MD Margaret Chiu, MD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor March 2021, Vol. 85, 29. https://doi.org/10.1097/01.ASM.0000737104.11746.18 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Margaret Chiu; FAME: A Resident's Reflection on a Tanzania Medical Trip. ASA Monitor 2021; 85:29 doi: https://doi.org/10.1097/01.ASM.0000737104.11746.18 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAll PublicationsASA Monitor Search Advanced Search Topics: fingolimod-associated macular edema, tanzania A teenage boy sat in the shade of the emergency department, his shoulders draped with a red plaid sheet. His feet sported distinctive Maasai sandals cut from old tire treads. He had been an inpatient of the hospital long before my arrival. My first time caring for him in the OR was for a washout of his septic knee. He had dark spots on the soles of his feet: Janeway lesions. My brain dug up this telltale sign for endocarditis that I diligently memorized in medical school – just one of many instances in Tanzania where I encountered something that I had previously only read about. Despite rounding on him daily and providing anesthesia for him on multiple occasions, I had maintained my distance. Instead of making an effort to connect, I busied myself with academic pursuits. I had... © 2021 American Society of Anesthesiologists (ASA), All Rights Reserved.2021 You do not currently have access to this content.

Fingolimod-associated macular edema controlled with nepafenac non-steroidal anti-inflammatory opthalmologic applications

BackgroundFingolimod, an immunomodulatory agent, is used for the treatment of relapsing–remitting multiple sclerosis (RRMS). Fingolimod-associated macular edema (FAME) is a known complication with an incidence of 0.4%. The current recommendation for treatment of FAME is cessation of fingolimod. There are few case reports with management of FAME with steroid eye drops.Case presentationA 38-year-old Caucasian female patient with history of relapsing–remitting multiple sclerosis (RRMS) and treated with fingolimod developed Fingolimod-associated macular edema (FAME). Nevertheless, FAME was successfully treated with nonsteroidal anti-inflammatory eye drops without discontinuation of fingolimod.ConclusionFAME may be managed with non-steroidal eye drops without discontinuation of fingolimod in appropriate patient monitored with close follow up.

Frühzeitiges Auftreten eines Fingolimod-assoziierten Makulaödems

Fingolimod, adisease-modifying sphingosine 1‑phosphate receptor modulator, which was approved in Germany in 2011, decreases the relapse rate and reduces neuroinflammation in patients with relapsing-remitting multiple sclerosis. Macular edema is awell-known ocular side effect of fingolimod therapy. Specific intervals for ophthalmologic check-ups after starting fingolimod and definite treatment schedules for fingolimod-associated macular edema are, however, still lacking. We present acase of early fingolimod-associated macular edema in a45-year-old female patient with relapsing-remitting multiple sclerosis. The patient complained about visual impairment 1 month after the start of fingolimod and visited an eye specialist. Funduscopic examination and imaging diagnostics revealed macular edema in both eyes. The treatment with fingolimod was immediately stopped. For therapy of macular edema topical application of nepafenac and oral acetazolamide were given. During the 6months of treatment the macular edema completely disappeared and visual function recovered completely. At the time of diagnosis, it is fundamentally important to discuss the continuation of fingolimod administration with the attending neurologist and if necessary to discontinue the drug. Regular ophthalmologic check-ups at 4‑week intervals over a period of 3 months are meaningful after beginning fingolimod treatment. As before, it is still akey aspect to determine predictive opthalmologic and neurological factors before beginning treatment to evaluate which patients are at risk of fingolimod-associated macular edema.

Visual consequences of medications for multiple sclerosis: the good, the bad, the ugly, and the unknown.

Multiple sclerosis (MS) is associated with vision changes both due to MS effects on visual pathways and due to medication effects on the visual pathways. Distinguishing the causes of vision change are critical to appropriate diagnosis and management. The incidence, presentation, and treatment of fingolimod-associated macular edema, alemtuzumab-associated thyroid orbitopathy, and progressive multifocal leukoencephalopathy in MS patients are reviewed. Evidence for beneficial effects of acute, chronic, and symptomatic MS medications on vision is presented.

Continuing fingolimod after development of macular edema: A case report.

Fingolimod is the first effective oral agent in widespread use for relapsing-remitting multiple sclerosis (MS), but it can cause macular edema (ME) as an uncommon complication. ME may be mild and asymptomatic, but it can also produce visual impairment. The mechanism of fingolimod-associated ME (FAME) is thought to be through sphingosine-1-phosphate receptor antagonism, affecting endothelial integrity and increasing the risk of microvascular leaks.1

Fingolimod-Associated Macular Edema: Resolution by Sub-Tenon Injection of Triamcinolone With Continued Fingolimod Use

Fingolimod-Associated Macular Edema: Resolution by Sub-Tenon Injection of Triamcinolone With Continued Fingolimod Use

Management of Fingolimod-Associated Macular Edema

Management of Fingolimod-Associated Macular Edema

Fingolimod-associated macular edema

Fingolimod (FTY-720), a sphingosine-1-phosphate receptor modulator, is the first US Food and Drug Administration (FDA)-approved oral agent for the treatment of relapsing forms of multiple sclerosis (MS). Two recent phase III clinical studies (TRANSFORMS [Trial Assessing Injectable Interferon vs FTY720 Oral in RRMS] and FREEDOMS [FTY720 Research Evaluating Effects of Daily Oral Therapy in MS]) demonstrated a significant reduction in the annualized relapse rate in patients with relapsing-remitting MS, compared to once weekly interferon β-1a and placebo. Macular edema was a prominent adverse event reported in these and prior studies of fingolimod. Thirteen of 2,564 (0.5%) patients treated with fingolimod in FREEDOMS and TRANSFORMS developed macular edema. Fingolimod-associated macular edema (FAME) appears to be dose-dependent (observed in only 2 patients taking the FDA-approved 0.5 mg dose) and typically resolves upon cessation of therapy. Although a relatively common condition in ophthalmology, most neurologists have not encountered macular edema in clinical practice. The purpose of this review is to educate the neurologist on the etiology, clinical manifestations, diagnostic modalities, and treatment approaches in patients with FAME. We also discuss the use of fingolimod in patients with uveitis and diabetes mellitus, highlight the guidelines for surveillance ophthalmic examination, and outline the key distinguishing features between FAME and optic neuritis.