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[Serous detection of the neuroretina in Waldenström disease. A case report]
Background:
Waldenstrom's Macroglobulinemia is a monoclonal gammopathy producing pathologic IgM antibodies with increased blood viscosity, platelet dysfunction and retinal hemorrhages. As a complication a serous detachment of the macula is described. The pathogenesis of the serous detachment is still not fully understood.
Case Report:
A 73-year-old male patient was presented with Waldenstrom's Macroglobulinemia, a typical hyperviscosity retinopathy and serous detachment of the macula. We performed fluorescein (FA)- and indocyaningreenangiography (ICG) before and three months after chemotherapy. Especially ICG-angiographic findings revealed a serous detachment that was restricted to the posterior pole but showed a fingershaped enlargement to the optic disc.
Conclusion:
FA- and especially ICG-angiographic findings can help to get more information about the pathogenetic mechanism of serous detachment in Waldenstrom's Macroglobulinemia. Besides toxic alteration of the retinal pigmentepithelium, oncotic and hydrostatic pressure, a pathologic communication between the optic disc, the subarachnoid space and the subretinal space is discussed.
Insights
Waldenstrom's Macroglobulinemia can cause serous macular detachment. Angiography reveals potential causes, including abnormal fluid pathways near the optic disc, aiding understanding of this rare complication.
Area of Science:
- Ophthalmology
- Hematology
- Medical Imaging
Background:
- Waldenstrom's Macroglobulinemia (WM) is a rare B-cell lymphoproliferative disorder.
- Pathologic IgM antibodies in WM cause hyperviscosity, leading to complications like retinal hemorrhages and macular edema.
- The pathogenesis of WM-associated serous macular detachment remains unclear.
Observation:
- A 73-year-old male with WM presented with hyperviscosity retinopathy and serous macular detachment.
- Fluorescein angiography (FA) and indocyanine green angiography (ICG) were performed before and after chemotherapy.
- ICG angiography highlighted a finger-shaped extension of the serous detachment towards the optic disc.
Findings:
- ICG angiography provided detailed insights into the serous detachment's morphology.
- Findings suggest potential pathogenesis involving retinal pigment epithelium toxicity, altered pressures, and abnormal fluid communication.
- A possible link between the optic disc, subarachnoid space, and subretinal space was identified.
Implications:
- Advanced imaging like ICG angiography is crucial for understanding WM-related macular complications.
- This study contributes to elucidating the complex pathogenesis of serous macular detachment in Waldenstrom's Macroglobulinemia.
- Further research may lead to targeted treatments for this specific ophthalmic manifestation of WM.