Bilateral, Persistent Serous Macular Detachments With Waldenstr??m???s Macroglobulinemia

Abstract

Although the funduscopic manifestations of excess serum immunoglobulins are typically the sequelae of circulatory stasis, the serum hyperviscosity induced in Waldenström's macroglobulinemia has been shown on rare occasions to induce serous macular detachments. Physical elimination of the excess macroglobulins through plasmapheresis is quite effective in resolving the neurosensory detachments induced by Waldenström's macroglobulinemia. Only a fraction of neurosensory detachments resulting from Waldenström's macroglobulinemia persist despite multiple plasmapheresis treatments. Novel angiographic evidence of retinal pigment epithelium atrophy beneath the area corresponding to the serous detachment provides a plausible explanation for unresponsive nature of this presentation. Identification of this rare variant of the classic angiographically silent macula known to occur with Waldenström's macroglobulinemia can aid the clinician in determining a patient's potential response to plasmapheresis and their final visual prognosis.