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

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.