Kim Min Young, Alkhabaz Anas, Smith Stephen J, Liao Yaping Joyce
Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA.
Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
Am J Ophthalmol Case Rep. 2024 Jul 22;36:102124. doi: 10.1016/j.ajoc.2024.102124. eCollection 2024 Dec.
This case report highlights the importance of monitoring ocular health for patients starting on siponimod treatment, a sphingosine-1-phosphate receptor modulator, for relapsing-remitting multiple sclerosis. By showing how medication adverse events present in patients, we can revisit the current guidelines on ophthalmic evaluation recommendations.
We report a 60-year-old patient who presented with unilateral blurry vision upon initiating siponimod therapy for the treatment of relapsing-remitting multiple sclerosis. Her exam findings did not show visual field defects but were significant for cystoid macular edema distorting the foveal contour. Upon stopping siponimod therapy, the patient's macular edema and symptoms resolved significantly within 7 days and completely resolved 1 month later.
This case showcases siponimod-associated cystoid macular edema in a patient without known risk factors, such as diabetes mellitus and uveitis. The patient also had the earliest reported symptom onset to date following the initiation of siponimod therapy. Current recommendations from the American Academy of Ophthalmology and FDA stress the importance of ophthalmic evaluation three to four months after treatment initiation for patients with a history of risk factors. Given our current case and its comparison with four previously reported cases, we recommend that physicians inform patients of possible ocular adverse events with siponimod therapy regardless of their past medical history and duration of treatment.
本病例报告强调了对于开始使用西尼莫德治疗复发缓解型多发性硬化症的患者监测眼部健康的重要性。通过展示患者出现的药物不良事件，我们可以重新审视当前关于眼科评估建议的指南。
我们报告了一名60岁的患者，在开始使用西尼莫德治疗复发缓解型多发性硬化症时出现单侧视力模糊。她的检查结果未显示视野缺损，但黄斑囊样水肿使黄斑中心凹轮廓变形，这一点很明显。停用西尼莫德治疗后，患者的黄斑水肿和症状在7天内明显缓解，并在1个月后完全缓解。
本病例展示了一名无糖尿病和葡萄膜炎等已知危险因素的患者出现的西尼莫德相关性黄斑囊样水肿。该患者也是迄今为止报道的西尼莫德治疗开始后症状出现最早的病例。美国眼科学会和美国食品药品监督管理局目前的建议强调，对于有危险因素病史的患者，在治疗开始后三到四个月进行眼科评估的重要性。鉴于我们目前的病例及其与之前报道的四个病例的比较，我们建议医生告知患者，无论其既往病史和治疗时间长短，西尼莫德治疗都可能存在眼部不良事件。
