Acetazolamide therapy in a case of fingolimod-associated macular edema: early benefits and long-term limitations

Abstract

Fingolimod is a potent drug in relapsing forms of multiple sclerosis. Visual impairment due to fingolimod-associated macular edema (FAME) usually leads to discontinuation of fingolimod therapy.

Methods: We report on a 24-year old woman with bilateral FAME.

Results: We continued fingolimod and added oral acetazolamide, which led to recovery of visual acuity and regression of macular edema. However, fingolimod had to be discontinued when fluorescein angiography revealed an enlarged foveal avascular zone.

Discussion and conclusion: Oral acetazolamide might be a treatment option for FAME, while ischemic conversion may be limiting. Ophthalmologic assessments are mandatory for follow-up when fingolimod therapy is continued after onset of FAME.

Keywords: Acetazolamide; Fingolimod; Macular edema; Multiple sclerosis.