An unusual maculopathy with macular detachment has been described in
patients with immunogammopathies. We observed this type of maculopathy in
a patient with type 2 diabetes mellitus and had the opportunity to study the
condition with optical coherence tomography. Optical coherence tomography
showed not only a neurosensory macular detachment, but also a retinal pigment
epithelium (RPE) detachment.
A 77-year-old man with type 2 diabetes mellitus had reading and driving
difficulties. Physical examination revealed poor diabetic control and monoclonal
IgMλ paraproteinemia (IgM level, 46 g/L; reference range, 0.4-2.3 g/L),
with 52% plasmocytes in bone marrow aspirate. There was mild anemia (hemoglobin
level, 9-11 g/L) and carotid insufficiency, with 50% to 80% stenosis of the
left internal carotid artery and no significant abnormalities in other arteries.
The patient was normotensive without intake of antihypertensive agents, and
there was no evidence of heart or kidney disease. Initially the diagnosis
of Waldenström syndrome was made, and the patient was treated accordingly
with intermittent plasmapheresis and chlorambucil. Eight months later, the
diagnosis was revised to IgM myeloma based on the typical plasma cell appearance
of malignant cells in the bone marrow, the presence of a few osteolytic lesions,
the absence of hepatosplenomegaly or lymphadenopathy, and progression under
chlorambucil treatment. Treatment was changed to 4 to 6 weekly courses of
melphalan and methylprednisolone.
Leys A, Vandenberghe P. Serous Macular Detachments in a Patient With IgM Paraproteinemia: An Optical Coherence Tomography Study. Arch Ophthalmol. 2001;119(6):911-913. doi: