A man in his 30s with Castleman disease 15 years post–lung transplant presented with decreased visual acuity greater in the right (20/60) than the left eye (20/30). Ocular history included herpes zoster ophthalmicus with corneal scarring, pseudophakia in the right eye, and steroid-induced cataract in the left eye. Slitlamp examination showed stromal thinning of the cornea in the right eye and posterior subcapsular cataract in the left eye. Fundus examination and fluorescein angiography demonstrated venous engorgement and tortuosity bilaterally (Figure). Optical coherence tomography was unremarkable in both eyes. Castleman disease has been associated with papilledema, optic neuropathy, and serous retinal detachment.1 One case report of Castleman disease documented bilateral blurred vision and retinal venous engorgement and tortuosity, most likely secondary to increased serum viscosity from increased cryoglobulin.2 However, its effect on this patient’s vision is likely mild, as the corneal scarring in the right eye and the cataract in the left eye are the probable causes of the patient’s decreased visual acuity.
Aung A, MacCumber MW. Castleman Disease and Retinal Vascular Tortuosity. JAMA Ophthalmol. 2017;135(2):e164660. doi:10.1001/jamaophthalmol.2016.4660