Irreversible visual loss in Waldenström's macroglobulinaemia.

Area of Science:

• Ophthalmology
• Hematology
• Oncology

Background:

• Waldenström's macroglobulinaemia is a rare lymphoproliferative disorder.
• This condition can lead to hyperviscosity syndrome, affecting ocular structures.

Observation:

• A patient presented with bilateral visual reduction.
• Funduscopic and angiographic findings included venous engorgement, retinal hemorrhages, edema, and serous macular detachment.
• Immunoglobulin cryoprecipitation complicated standard laboratory procedures.

Findings:

• Plasmapheresis, performed at a controlled temperature, improved retinal appearance but did not restore vision.
• Perifoveal capillary nonperfusion and persistent macular edema were noted.
• No visual recovery occurred despite macular flattening.

Implications:

• Early clinical diagnosis of Waldenström's macroglobulinaemia is vital, even if lab studies are delayed.
• Prompt plasmapheresis is recommended to reduce serum viscosity and prevent retinal vascular complications.
• Timely intervention may prevent irreversible vision loss from intravascular occlusion and retinal deposition.