Evaluation of the effect of fingolimod (FTY720) on macular perfusion by swept-source optical coherence tomography angiography in patients with multiple sclerosis

Aim: To determine changes in retinal microcirculation, caused by fingolimod (FTY720) use, via swept-source optical coherence tomography angiography (SS-OCTA) in relapsing-remitting multiple sclerosis (RR-MS) patients. Materials and methods: 80 patients with RR-MS, who were using fingolimod, and 50 healthy control subjects were included in the study. Group 1 consisted of 40 eyes from 40 RR-MS patients, who had been using fingolimod for less than six months, and Group 2 consisted of 40 eyes from 40 RR-MS patients, who had been using fingolimod for longer than six months. All participants underwent SS-OCTA via DRI OCT Triton (Topcon, Tokyo, Japan), analysing their central macular thickness (CMT) (µm), subfoveal choroidal thickness (SFCT) (µm), superficial (VDs) (%) and deep vascular plexuses (VDd) (%), choriocapillaris (VDcc) (%), and superficial and deep foveal avascular zones (FAZs, FAZd, respectively) (%) in mean values. Results: The mean follow-up times for patients in Groups 1 and 2 were 2.9 ± 1.5 months and 22.5 ± 11.3 months, respectively. The FAZs value in Group 2 was found to be significantly higher than that in both Group 1 and the control group (p = 0.034, p = 0.042, respectively). The VDs central value in Group 2 did not differ significantly from that in Group 1 or the control group (p > 0.05), while the VDs central value was higher in Group 1 than in the control group (p = 0.008). In Group 1, the VDd central value was significantly higher than in Group 2 and the control group (p = 0.047; p = 0.020, respectively). The CMT measurement for Group 2 was significantly lower than in Group 1 and the control group (p = 0.008, p = 0.003, respectively). Conclusion: Fingolimod use seems to remarkably increase VDs and VDd measurements in the early period of administration and decrease CMT over a longer period of administration in patients with RR-MS.