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Updated: Aug 16, 2026

A Protocol to Evaluate and Quantify Retinal Pigmented Epithelium Pathologies in Mouse Models of Age-Related Macular Degeneration
Published on: March 10, 2023
PARACENTRAL ACUTE MIDDLE MACULOPATHY AS AN EARLY SIGN OF WALDENSTRÖM MACROGLOBULINEMIA
Ross M Passo1, Brittni A Scruggs, Steven T Bailey
1Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon. Dr. Scruggs is now with the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
Purpose:
To report a case of paracentral acute middle maculopathy as the earliest sign of an undiagnosed, life-threatening hyperviscosity syndrome.
Methods:
A 78-year-old man with an acute paracentral scotoma and examination findings of bilateral arteriolar tortuosity and unilateral paracentral acute middle maculopathy.
Results:
Work-up revealed anemia and elevated serum viscosity. Protein electrophoresis demonstrated an immunoglobulin M kappa monoclonal protein spike, and bone marrow biopsy confirmed an immunoglobulin M gammopathy consistent with Waldenström macroglobulinemia. Systemic chemotherapy was initiated.
Conclusion:
This case demonstrates typical optical coherence tomography findings of paracentral acute middle maculopathy, which led to the diagnosis of a rare lymphoproliferative disorder. This highlights the importance of a prompt work-up for paracentral acute middle maculopathy to detect underlying systemic diseases, including hyperviscosity syndromes.
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