Postoperative cystoid macular oedema in a patient on fingolimod

Abstract

We describe the first case of fingolimod-associated bilateral cystoid macular oedema (CMO) following uncomplicated cataract surgery. A 57-year-old woman has been on fingolimod for the past 2 years for the treatment of relapsing-remitting multiple sclerosis. She underwent uneventful consecutive cataract surgery 2 weeks apart. Three weeks following the second cataract operation, she reported gradual-onset blurred vision bilaterally. Examination revealed mildly reduced visual acuity and bilateral CMO. Treatment with topical corticosteroids and non-steroidal anti-inflammatory eye drops, as well as cessation of fingolimod in collaboration with the neurologist, resulted in complete resolution of the CMO. Patients on fingolimod are likely to be at increased risk of developing postoperative CMO.

Figure 1

Macular optical coherence tomography (OCT) of the patient's right eye: (A) preoperative scan; (B) 5 weeks post-right cataract surgery, demonstrating cystoid macular oedema (CMO) with a corresponding central foveal thickness of 573 μm; (C) 6 weeks post-right cataract surgery, demonstrating slightly improved macular oedema, with a corresponding central foveal thickness of 497 μm; (D) 8 weeks post-right cataract surgery, demonstrating residual parafoveal cysts, with corresponding central foveal thickness of 332 μm; (E) 12 weeks post-right cataract surgery, demonstrating complete resolution of CMO, with corresponding central foveal thickness of 297 μm.

Figure 2

Macular optical coherence tomography (OCT) of the patient's left eye: (A) preoperative scan; (B) 3 weeks post-left cataract surgery, demonstrating cystoid macular oedema (CMO) with a corresponding central foveal thickness of 478 μm; (C) 4 weeks post-left cataract surgery, demonstrating significantly improved macular oedema, with a corresponding central foveal thickness of 404 μm; (D) 6 weeks post-left cataract surgery, demonstrating resolved macular oedema with residual subfoveal hyper-reflectivity. The corresponding central foveal thickness was 316 μm; (E) 10 weeks post-left cataract surgery, demonstrating complete resolution of CMO, with corresponding central foveal thickness of 324 μm.