Journal of Ophthalmic Science

Journal of Ophthalmic Science

Current Issue Volume No: 3 Issue No: 2

Case-report Article Open Access
  • Available online freely Peer Reviewed

  • Leflunomide-Induced Cystoid Macular Edema: A Rare Case Report

    1 Ophthalmology Department, Unidade Local de Saude Entre Douro e Vouga, Santa Maria da Feira, Portugal 

    Abstract

    Introduction

    Cystoid macular edema (CME) is a sight-threatening condition caused by fluid accumulation in the macula due to blood-retinal barrier disruption. Various factors, including drug reactions, can lead to retinal fluid leakage. Leflunomide, a disease-modifying anti-rheumatic drug, marked significant progress in managing rheumatoid arthritis. Although effective, Leflunomide has rarely been linked to CME. This report presents a unique case of Leflunomide-induced CME, adding to the limited literature on this subject.

     Methods

    We report the case of a 75-year-old female with rheumatoid arthritis treated with Leflunomide, presenting with bilateral CME and reduced visual acuity (VA). Comprehensive ophthalmic evaluations, including VA tests, fundus examination, and optical coherence tomography, were conducted.

     Results

    The patient presented with CME and decreased VA in both eyes for several months. She had undergone cataract surgery 20 years prior and was using topical nepafenac, dorzolamide, and dexamethasone. Initial VA was OD 20/50 and OS 20/40. VA improved with treatment, but CME recurred upon discontinuation. The patient had been on Leflunomide for one year. After consulting with the Rheumatology department and considering a previous case of bilateral Leflunomide-induced CME, the drug was discontinued. CME resolved without recurrence or the need for topical treatment. At her final visit, VA was OU 20/25.

     Conclusion

    This case highlights Leflunomide as a potential, though rare, cause of CME. It emphasizes considering systemic medications in CME diagnosis. Timely discontinuation of Leflunomide may resolve CME and prevent further visual impairment. Further studies are needed to understand this rare side effect comprehensively.
    Author Contributions
    Received Jun 21, 2024     Accepted Jul 31, 2024     Published Aug 06, 2024

    Copyright© 2024 Alves Ambrósio João, et al.
    License
    Creative Commons License   This work is licensed under a Creative Commons Attribution 4.0 International License. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors declare no conflict of interest.

    Funding Interests:

    Citation:

    Alves Ambrosio Joao, Pestana Aguiar Catarina, Cardoso Teixeira Pedro, Cardoso Costa Joao, Chibante Pedro Joao et al. (2024) Leflunomide-Induced Cystoid Macular Edema: A Rare Case Report Journal of Ophthalmic Science. - 3(2):1-5
    DOI 10.14302/issn.2470-0436.jos-24-5162

    Introduction

    Introduction

    The American Academy of Ophthalmology defines Cystoid Macular Edema (CME) as the retinal thickening of the macula caused by a disruption of the blood-retinal barrier. This disruption leads to leakage from the perifoveal retinal capillaries and fluid accumulation within the intracellular spaces of the retina, primarily in the outer plexiform layer. 12 Visual loss occurs due to retinal thickening and fluid collection that distorts the architecture of the photoreceptors. The etiology of CME is multifaceted, encompassing various systemic and local factors, including ocular surgeries, inflammatory diseases, and adverse drug reactions. A variety of these risk factors can disrupt the delicate balance within the retinal environment, which involves the osmotic force, hydrostatic force, capillary permeability, and tissue compliance within the vasculature. Among the drugs known to cause CME, Leflunomide has been identified as a rare contributor. 3 Leflunomide, an immunomodulatory drug, was the first oral agent labeled for managing active rheumatoid arthritis by slowing disease progression, reducing joint damage, and alleviating symptoms. This represented a significant advancement in rheumatoid arthritis treatment. 4 To the best of our knowledge, just one case report exists in the literature documenting Leflunomide-induced bilateral CME.

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