Schelenz D, Kleiter I, Schöllhammer J, Rehrmann J, Elling M, Dick H B, Kakkassery V
Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Deutschland.
Klinik für Neurologie, Katholisches Klinikum Bochum, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
Ophthalmologe. 2018 May;115(5):424-428. doi: 10.1007/s00347-017-0526-7.
Fingolimod, a disease-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 a well-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 a case of early fingolimod-associated macular edema in a 45-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 6 months 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 a key aspect to determine predictive opthalmologic and neurological factors before beginning treatment to evaluate which patients are at risk of fingolimod-associated macular edema.
芬戈莫德是一种疾病修饰性鞘氨醇-1-磷酸受体调节剂，于2011年在德国获批，可降低复发缓解型多发性硬化症患者的复发率并减轻神经炎症。黄斑水肿是芬戈莫德治疗众所周知的眼部副作用。然而，开始使用芬戈莫德后眼科检查的具体间隔时间以及芬戈莫德相关黄斑水肿的明确治疗方案仍不明确。
我们报告一例45岁复发缓解型多发性硬化症女性患者早期出现芬戈莫德相关黄斑水肿的病例。患者在开始使用芬戈莫德1个月后出现视力障碍，并就诊于眼科专家。眼底检查和影像学诊断显示双眼黄斑水肿。立即停用芬戈莫德。对于黄斑水肿的治疗，给予局部应用奈帕芬酸和口服乙酰唑胺。在治疗的6个月期间，黄斑水肿完全消失，视力功能完全恢复。
在诊断时，与主治神经科医生讨论是否继续使用芬戈莫德并在必要时停药至关重要。开始使用芬戈莫德治疗后，在3个月内每隔4周进行定期眼科检查是有意义的。和以前一样，在开始治疗前确定预测性的眼科和神经学因素以评估哪些患者有发生芬戈莫德相关黄斑水肿的风险仍然是一个关键方面。
