Download fulltext HTML
1.
Jayadev C, Gupta I, Gopi Krishna Gadde S. Atypical Refractory Macular Edema: Are We Missing Something?. JOVR [Internet]. 2022Aug.9 [cited 2024Jul.17];17(3):437–442. Available from: https://knepublishing.com/index.php/JOVR/article/view/11584

https://doi.org/10.18502/jovr.v17i3.11584

statistics

  • 648 Abstract Views
  • 384 PDF Views
  • 0 HTML Views

authors

  • Chaitra Jayadev

    Chaitra Jayadev

    Department of Vitreoretina, Narayana Nethralaya Eye Institute, Bangalore, India
    https://orcid.org/0000-0001-8392-7159
  • Ishank Gupta

    Ishank Gupta

    Department of Vitreoretina, Narayana Nethralaya Eye Institute, Bangalore, India
  • Santosh Gopi Krishna Gadde

    Santosh Gopi Krishna Gadde

    Department of Vitreoretina, Narayana Nethralaya Eye Institute, Bangalore, India

Published Date

  • Aug 9, 2022
This journal is publishing all the articles under Creative Commons Attribution License CC BY 4.0.

Atypical Refractory Macular Edema: Are We Missing Something?

Journal of Ophthalmic and Vision Research (JOVR) / July–Sep 2022, Volume 17, Issue 3 / Pages 437–442

Abstract

Purpose: To report a case of bilateral refractory macular edema in a diabetic macular edema in a diabetic with an underlying systemic illness. Case Report: 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. Conclusion: 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.

Keywords:

Atypical Macular Edema, Multiple Myeloma, Paraproteinemic Maculopathy, Serous Macular Detachment

References
1. Coscas G, editor. Macular edema. 2nd, revised and extended edition. In: Bandello F, editor Developments in ophthalmology. Volume 58. Basel: Karger; 2017. p. 102–138.

2. Bandello F, Battaglia Parodi M, Lanzetta P, Loewenstein A, Massin P, Menchini F, et al. Diabetic macular edema. Dev Ophthalmol 2017;58:102–38.

3. Otani T, Kishi S, Maruyama Y. Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol 1999;127:688–693.

4. Hikichi T, Ohtsuka H, Higuchi M, Matsushita T, Ariga H, Kosaka S, et al. Causes of macular serous retinal detachments in Japanese patients 40 years and older. Retina 2009;29:395–404.

5. lanary WE, Meirick TM, Boldt HC. Waldenstrom macroglobulinema-associated retinopathy. EyeRounds.org; 2015.

6. Wilkinson CP, Ferris FL 3rd , Klein RE, Lee PP, Agardh CD, Davis M, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 2003;110:1677–1682.

7. Mansour AM, Arevalo JF, Badal J, Moorthy RS, Shah GK, Zegarra H, et al. Paraproteinemic maculopathy. Ophthalmology 2014;121:1925–1932.

8. Baker PS, Garg SJ, Fineman MS, Chiang A, Alshareef RA, Belmont J, et al. Serous macular detachment in Waldenström macroglobulinemia: A report of four cases. Am J Ophthalmol 2013;155:448–455.

9. Besirli CG, Johnson MW. Immunogammopathy maculopathy associated with Waldenström macroglobulinemia is refractory to conventional interventions for macular edema. Retin Cases Brief Rep 2013;7:319–324.

10. Lin CJ, Chiu YM, Chen SN, Hwang JF, Hu PS. Unusual maculopathy secondary to hypergammaglobulinemia in a patient with systemic lupus erythematosus. Retin Cases Brief Rep 2012;6:27–29.

11. Berta A, Beck P, Mikita J. IgM paraprotein in the subretinal fluid of a patient with recurrent retinal detachment and Waldenström’s macroglobulinaemia. Acta Med Hung 1985;42:179–186.

12. Menke MN, Feke GT, McMeel JW, Treon SP. Effect of plasmapheresis on hyperviscosity-related retinopathy and retinal hemodynamics in patients with Waldenstrom’s macroglobulinemia. Invest Ophthalmol Vis Sci 2008;49:1157–1160.

13. Georgakopoulos CD, Plotas P, Angelakis A, Kagkelaris K, Tzouvara E, Makri OE. Dexamethasone implant for immunogammopathy maculopathy associated with IgA multiple myeloma. Ther Adv Ophthalmol 2019;11:2515841418820441.

14. Krishnappa NC, Ganne P. Paraproteinemic maculopathy in a 63-year-old man. JAMA Ophthalmol 2018;136:944–945.