A 74-YEAR-OLD man had sudden, painless, decreased vision in the right eye. Visual acuity was 20/400 OD and 20/20 OS. Intraocular pressure in both eyes showed no abnormalities. The patient was aphakic in both eyes after bilateral intracapsular cataract extraction. Findings from a dilated funduscopic examination revealed a right central retinal vein occlusion (CRVO), a vitreous hemorrhage in the right eye (Figure 1), and the absence of dilated, sausage-shaped retinal veins suggestive of coagulopathy. The patient's ophthalmic history was negative for hypertension, diabetes mellitus, or atherosclerotic disease, but positive for fevers, weight loss, and night sweats, which prompted further assessment. Laboratory test results were as follows: an elevated Westergren erythrocyte sedimentation rate, 126 mm/h (reference range, 0-35 mm/h); hemoglobin, 127 g/L (reference range, 140-175 g/L); hematocrit, 0.04 (reference range, 0.41-0.50); total protein, 86 g/L (reference range, 62-82 g/L); and albumin, 31 g/L (reference range, 30-50 g/L). Serum viscosity was elevated at 3.4 centistokes (reference range, 1.4-2.2 centistokes). Serum protein electrophoresis revealed an increased IgG fraction of 46.7 g/L (reference range, 8.0-18.0) and a lambda (λ) light chain of 2820 mg/dL (reference range, 304-755 mg/dL) (Figure 2). λ Light chains were elevated in the urine (Figure 3). A whole-body computed tomographic scan showed prevascular and paratracheal adenopathy (Figure 4). Bone marrow aspiration and biopsy results (Figure 5 and Figure 6) were consistent with a well-differentiated lymphocytic lymphoma. The diagnosis of low-grade lymphoma with a secondary monoclonal gammopathy was made and the patient was prescribed combined therapy of chlorambucil and prednisone.
Enzenauer RW, Brozetti JJ, Dragoo RA. Central Retinal Vein Occlusion in a Patient With IgG Lambda Monoclonal Gammopathy. Arch Ophthalmol. 1999;117(1):134-135. doi:10.1001/archopht.117.1.134