Fingolimod: therapeutic mechanisms and ocular adverse effects.

Fingolimod is an oral immunomodulating drug used in the management of relapsing-remitting multiple sclerosis (RRMS). We aim to review the published literature on ocular manifestations of fingolimod therapy and their possible underlying mechanisms. The therapeutic effects of fingolimod are mediated via sphingosine receptors, which are found ubiquitously in various organs, including lymphoid cells, central nervous system, cardiac myocytes, and smooth muscle cells. Fingolimod-associated macular oedema (FAME) is the most common ocular side effect but retinal haemorrhages and retinal vein occlusion can occur. The visual consequences appear to be mild and, in cases of FAME, resolution is often attained with discontinuation of therapy. However, in cases of retinal vein occlusion, discontinuation of fingolimod alone may not be sufficient and intra-vitreal therapy may be required. We also propose a pragmatic service pathway for monitoring patients on fingolimod therapy, which includes stratifying them by risk and visual acuity

Retinal and Vitreous Hemorrhage after Traumatic Impact of Dexamethasone Implant in a Vitrectomized Eye

PURPOSE: To report a case of retinal and vitreous hemorrhage after intravitreal injection of dexamethasone implant (0.7 mg Ozurdex) and its management.METHODS: A 49-year-old man treated for diabetic macular edema developed vitreous and retinal hemorrhage after intravitreal injection of dexamethasone implant caused by a retinal impact during the injection procedure.RESULTS: Retinal and vitreous hemorrhage absorbed spontaneously after 3 months. No retinal damage was detected. Intraocular pressure increased to 38 mm Hg after the injection and was well-controlled by medical therapy (dorzolamide hydrochloride-timolol maleate ophthalmic solution administered BID and oral acetazolamide 250 mg once a day). Since the surgeon performed the injection carefully without exerting any pressure on the eye, a device malfunction likely caused the implant to be injected too powerfully.CONCLUSIONS: Vitreous and retinal hemorrhage can occur after direct impact of an Ozurdex implant against the retina during the injection. So far this has never been described in the literature. Intraocular pressure elevation can worsen due to trabecular blockage by red blood cells. Spontaneous resolution can occur but vitrectomy is a therapeutic option if the hemorrhage persists

Characteristics of cases (CNS TB).

Characteristics of cases (CNS TB).</p

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