Abstract
A patient with Waldenström's macroglobulinaemia presented with visual reduction in both eyes. The funduscopic and angiographic demonstrations of venous engorgement ('string of sausages'), retinal haemorrhages at all levels, retinal and disc oedema, and serous detachment of the maculas were consistent with this diagnosis. The cryoprecipitation of the immunoglobulin at a temperature slightly below body temperature precluded routine blood studies and plasmapheresis. Plasmapheresis was ultimately performed without difficulty with the patient and equipment at 88 degrees F (31 degrees C). Despite marked improvement in the funduscopic and angiographic appearance of the retina, perifoveal capillary nonperfusion and serous elevation of the macula persisted. Even when the maculas flattened in both eyes, no visual recovery occurred. Early diagnosis, even on a clinical basis when laboratory studies cannot be performed, and early plasmapheresis to reduce serum viscosity are warranted to prevent intravascular occlusion in the perifoveal capillary bed, deposition of immunoglobulin in the retina, and transudation in the subretinal space.
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- Asdourian G. K., Nagpal K. C., Busse B., Goldbaum M., Patriankos D., Rabb M. F., Goldberg M. F. Macular and perimacular vascular remodelling sickling haemoglobinopathies. Br J Ophthalmol. 1976 Jun;60(6):431–453. doi: 10.1136/bjo.60.6.431. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Freidman A. H., Marchevsky A., Odel J. G., Gerber M. A., Thung S. N. Immunofluorescent studies of the eye in Waldenström's macroglobulinemia. Arch Ophthalmol. 1980 Apr;98(4):743–746. doi: 10.1001/archopht.1980.01020030737020. [DOI] [PubMed] [Google Scholar]
- Grindle C. F., Buskard N. A., Newman D. L. Hyperviscosity retinopathy. A scientific approach to therapy. Trans Ophthalmol Soc U K. 1976 Jul;96(2):216–219. [PubMed] [Google Scholar]
- Orellana J., Friedman A. H. Ocular manifestations of multiple myeloma, Waldenström's macroglobulinemia and benign monoclonal gammopathy. Surv Ophthalmol. 1981 Nov-Dec;26(3):157–169. doi: 10.1016/0039-6257(81)90065-5. [DOI] [PubMed] [Google Scholar]
- PACHTER M. R., JOHNSON S. A., NEBLETT T. R., TRUANT J. P. Bleeding platelets, and macroglobulinemia. Am J Clin Pathol. 1959 Jun;31(6):467–482. doi: 10.1093/ajcp/31.6.467. [DOI] [PubMed] [Google Scholar]
- Rosen E. S., Simmons A. V., Warnes T. W. Retinopathy of Waldenström's macroglobulinemia: photographic assessment. Am J Ophthalmol. 1968 May;65(5):696–706. doi: 10.1016/0002-9394(68)94384-5. [DOI] [PubMed] [Google Scholar]
- SCHWAB P. J., OKUN E., FAHEY J. L. Reversal of retinopathy in Waldenstrom's macroglobulinemia by plasmapheresis. A report of two cases. Arch Ophthalmol. 1960 Oct;64:515–521. doi: 10.1001/archopht.1960.01840010517006. [DOI] [PubMed] [Google Scholar]