Bilateral fingolimod-associated macular oedema development after cataract surgery

Abstract

Postoperative cystoid macular oedema (CMO) is a recognised complication of cataract surgery, occurring in around 1.5% of cases. It is generally managed with topical steroids or non-steroidal anti-inflammatory medications. We present a case of a patient who developed bilateral sequential CMO following bilateral sequential cataract surgery which was non-responsive to topical therapy and worsened following sub-Tenons administration of steroid. The patient took fingolimod for multiple sclerosis both prior to and during the period of cataract surgery which is known to result in the development of macular oedema in some patients. On fingolimod cessation, the oedema resolved over a period of 5 months with good visual recovery. We present this case to inform cataract surgeons of the risk of fingolimod-associated macular oedema in patients undergoing cataract surgery and to inform neurologists of the potential need to adjust treatment for patients undergoing cataract surgery.

Keywords: contraindications and precautions; eye; multiple sclerosis; retina.

Figure 1

Macular optical coherence tomography (OCT) scans taken during course of treatment. The right side of the image represents the right eye and the left side of the image represents the left. (A) Preoperative macular OCT scans; (B) development of cystoid macular oedema in both eyes; (C) 2 weeks after sub-Tenons injection; (D) 10 days after cessation of fingolimod; (E) 4 months after cessation of fingolimod; (F) final visit 5 months after cessation of fingolimod.