Hyperviscosity-Related Retinopathy in Waldenström’s Macroglo
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A 60-year-old man presented with a 2-month history of bilateral blurry vision. The best corrected visual acuity was 10/20 in each eye. Funduscopic examination revealed bilateral retinal-vein dilatation and tortuosity with retinal hemorrhages (Panels A and B show the right and left eyes, respectively). Fluorescein angiography revealed retinal-vein beading patterns with multiple aneurysmal changes and vessel-wall staining (Panels C and D). Serum protein immunofixation assay showed prominent monoclonal bands against the antiserum of IgM and kappa light chains. Bone marrow biopsy revealed infiltration of plasmacytoid lymphocytes (10 to 13%) with expression of CD138 and CD20 markers. After seven rounds of plasmapheresis, visual acuity gradually improved to 20/20. Follow-up funduscopic examination revealed resolution of retinal-vein abnormality. Waldenström’s macroglobulinemia is a lymphoproliferative B-cell disorder characterized by the overproduction of monoclonal IgM...

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