Fingolimod-associated severe bilateral cystoid macular edema

PURPOSE: To report a rare case in which a patient undergoing long-term oral fingolimod treatment for multiple sclerosis (MS) developed late-onset severe bilateral cystoid macular edema (ME) at 3-weeks post cataract surgery. OBSERVATIONS: This study involved a 61-year-old female undergoing long-term oral fingolimod treatment for MS in whom at 4-years post initiation of treatment and the treatment being tapered to a 0.5 mg twice-weekly dose severe bilateral cystoid ME occurred at 3-weeks post cataract surgery. Although the patient was administered the proper treatments for pseudophakic ME, including a 20-mg sub-Tenon's-capsule triamcinolone acetonide injection, it took 13 months for the ME to ultimately resolve with continued oral fingolimod treatment. CONCLUSIONS AND IMPORTANCE: The findings in this study show that severe bilateral cystoid ME can occur even several years after initiating fingolimod treatment, thus indicating that detailed follow-up is necessary post cataract surgery.