Fingolimod-Associated Central Serous Retinopathy Presenting Eight Years after Treatment Initiation: a Case Report

Abstract

Fingolimod is an efficacious treatment option in the management of multiple sclerosis, while variable ocular adverse effects have been associated with its use. Herein, we present a case with development of central serous retinopathy (CSR) in the long-term after commencement of fingolimod treatment. A 53-year-old female with relapsing-remitting multiple sclerosis presented with central vision metamorphopsia in the left eye. Medical history revealed that the patient had been on treatment with fingolimod for eight years. Ophthalmological examination revealed retinal findings suggestive of CSR changes. Given the necessity to continue fingolimod treatment, the patient commenced topical nonsteroidal anti-inflammatory (nepafenac) medication for the retinal condition. There was a prompt and successful resolution of fluid following treatment; however, a subsequent presumed ocular surface disease urged the discontinuation of anti-inflammatory drops. Four weeks later, the patient presented with recurrence of fluid in the subRPE level. Thereafter, fingolimod treatment was switched to dimethyl fumarate. The patient's condition remained clinically stable without recurrence of fluid during a three-month follow-up period. Our case provides insight into the fingolimod associated retinal findings manifesting as CSR changes, indicating that ocular complications may occur even in the long-term, while discontinuation of treatment may lead to reversal of structural findings and maintain functional outcomes.

FIGURE 1.

Fundus infrared photos showing normal macula in the right eye and findings consistent with acute central serous retinopathy in the left eye during patient’s first visit

FIGURE 2.

Spectral domain optical coherence tomography imaging confirming a normal scan in the right eye and a serous detachment of the retinal pigment epithelium (RPE) with fluid accumulation at the subRPE level in the left eye

FIGURE 3.

Optical coherence tomography angiography confirming the vascular alterations consistent with central serous retinopathy and excluding the development of choroidal neovascular complex

FIGURE 4.

Spectral domain optical coherence tomography images of the patient’s left eye showing: a) resolution of fluid following treatment; b) recurrence of fluid at the subRPE level following discontinuation of topical treatment with non-steroidal antiinflammatory drops; c) resolution of fluid after switch of fingolimod to dimethyl fumarate (commercial name Teclifedera); and d) no fluid recurrence three months later.