Atypical Refractory Macular Edema: Are We Missing Something?

To report a case of bilateral refractory macular edema in a diabetic macular edema in a diabetic with an underlying systemic illness.

A 65-year-old male presented with the symptom of blurred vision in both eyes for three months. He was a known diabetic patient and was also hypertensive for the last 10 years. The corrected distance visual acuity was 20/120 in the right eye and 20/80 in the left eye. Fundus examination revealed multiple deep and superficial retinal hemorrhages, cystoid macular edema, and serous macular detachment in both eyes. With a diagnosis of diabetic macular edema in both eyes, the patient was treated with multiple intravitreal injections of anti-vascular endothelial growth factor and steroids. Since he did not show a favorable response, the patient was further investigated and diagnosed with multiple myeloma. After undergoing treatment for the same, the patient was seen a year later and noted to have significant resolution of the macular edema and subretinal fluid in both eyes.

In patients who suffer with atypical macular edema that is resistant to conventional treatment, it is imperative to look for underlying systemic illnesses such as immunoproliferative disorders and hematologic malignancies.