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Goncalves L, Pulido J. Immunogammopathy Maculopathy. Mayo Clin Proc 2024; 99:844-845. [PMID: 38551540 DOI: 10.1016/j.mayocp.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 05/05/2024]
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Nguyen NV, Konstantinou EK, Sherif N, Soifer M, Patronas M, Allen J, Bellur SS, Kodati S. Bilateral Exudative Retinal Detachments and Panuveitis in a Patient with Multiple Myeloma. Ocul Immunol Inflamm 2023:1-6. [PMID: 37290057 DOI: 10.1080/09273948.2023.2217914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE To report a case of bilateral exudative retinal detachments and panuveitis in a patient with multiple myeloma (MM). CASE REPORT A 54-year-old patient with non-proliferative diabetic retinopathy was referred with blurred vision and scotomas in both eyes (OU). Three months prior to the onset of ocular symptoms, he was diagnosed with systemic MM and was receiving chemotherapy. Clinical examination revealed best-corrected visual acuities of 20/80 OU, rare anterior chamber cell, 2+ vitreous cell, diffuse intraretinal hemorrhages, and exudative retinal detachments (RD). Optical coherence tomography of the macula showed central subretinal fluid with cystic intraretinal fluid OU. The findings were consistent with panuveitis and exudative RD in the setting of MM. He reported symptomatic improvement after plasmapheresis and oral prednisone initiation. CONCLUSION Extensive, bilateral exudative RD and panuveitis are rare but potentially sight-threatening findings in patients with MM.
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Affiliation(s)
- Nam V Nguyen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Noha Sherif
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matias Soifer
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marena Patronas
- Department of Ophthalmology, George Washington University, Washington, District of Columbia, USA
| | - Joshua Allen
- Department of Oncology, Inova Schar Cancer Institute, Fairfax, Virginia, USA
| | - Sunil S Bellur
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shilpa Kodati
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
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Houghton OM. Bilateral Refractory Neurosensory Retinal and Pigment Epithelial Detachments. JAMA Ophthalmol 2022; 140:829-830. [PMID: 35588351 DOI: 10.1001/jamaophthalmol.2022.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Wu JH, Viruni N, Chun J, Shanbhag S, Liu TA. Ocular involvement in TEMPI syndrome. Am J Ophthalmol Case Rep 2022; 26:101534. [PMID: 35496764 PMCID: PMC9043672 DOI: 10.1016/j.ajoc.2022.101534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 12/21/2022] Open
Abstract
Purpose We report the first case of ocular involvement in TEMPI syndrome, a rare disease characterized by telangiectasias, elevated erythropoietin with erythrocytosis, monoclonal gammopathy, perinephric fluid collections, and intra-pulmonary shunting. Observations A 64-year-old Caucasian man with history of TEMPI syndrome presented with subacute bilateral painless vision loss. Ocular examination showed chronic retinal ischemia with microvascular damage, which was likely associated with the chronic systemic hypoxemia, and spontaneous wax and wane of cystoid macular edema, presumedly related to the systemic bortezomib treatment. Conclusions and importance Our case demonstrates that pathologic retinal vascular changes could be seen in association with TEMPI syndrome and suggests that a comprehensive ophthalmological examination may be beneficial for these patients.
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Affiliation(s)
- Jo-Hsuan Wu
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California, San Diego, CA, 92093, USA
| | - Narine Viruni
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Justin Chun
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Satish Shanbhag
- Cancer Specialists of North Florida, Fleming Island, FL, 32003, USA
| | - T.Y. Alvin Liu
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, 21287, USA
- Corresponding author. Wilmer Eye Institute, 600 N. Wolfe St., Maumenee 726, Baltimore, MD, 21287, USA.
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Salcedo Mafla E, Gutiérrez Benítez L, Asaad M. Retinopathy secondary to multiple myeloma treated with bevacizumab. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:516-520. [PMID: 32636041 DOI: 10.1016/j.oftal.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
The case is presented on an 80-year-old woman with IgA multiple myeloma (MM), who developed retinal changes similar to mild non-proliferative diabetic retinopathy, with micro-aneurysms and intraretinal fluid. The patient was treated with systemic chemotherapy for MM, and with bevacizumab intravitreal injections, with control of her ocular disorder for 22 months. Anti-angiogenic therapy can be useful in the control of retinopathy secondary to MM, as long as the systemic disease has been controlled.
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Affiliation(s)
- E Salcedo Mafla
- Consorci Sanitari de Terrassa, Servicio de Oftalmología, Terrassa, Barcelona, España.
| | - L Gutiérrez Benítez
- Consorci Sanitari de Terrassa, Servicio de Oftalmología, Terrassa, Barcelona, España
| | - M Asaad
- Consorci Sanitari de Terrassa, Servicio de Oftalmología, Terrassa, Barcelona, España
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Rao K, Murthy H, Muralidhar NS, Rani PK. Multiple myeloma masquerading as diabetic macular oedema. BMJ Case Rep 2018; 2018:bcr-2017-223485. [PMID: 29666084 DOI: 10.1136/bcr-2017-223485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 58-year-old man, a known diabetic and hypertensive for 5 years was presented to us with a drop in reading vision in both eyes of 2 months duration. His best-corrected visual acuity was 6/24, N36 in both eyes. Fundus findings revealed moderate non-proliferative diabetic retinopathy with bilateral diffuse macular oedema. When conventional therapy with intravitreal ranibizumab did not alter the clinical picture, we looked into the differential diagnosis of bilateral persistent macular detachments and investigated further. Haematological tests revealed severe anaemia with pancytopenia, which prompted further investigations including a bone marrow biopsy confirming a diagnosis of multiple myeloma. Chemotherapy gradually caused resolution of the macular detachments at 8 months follow-up. This report illustrates that a high index of suspicion regarding systemic condition is required in certain cases presenting as diabetic macular oedema, but not responding to the conventional treatment.
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Affiliation(s)
- Kavitha Rao
- Department of Vitreoretina, Retina Institute of Karnataka, Bengaluru, India
| | - Hemanth Murthy
- Department of Vitreoretina, Retina Institute of Karnataka, Bengaluru, India
| | - N S Muralidhar
- Department of Vitreoretina, Retina Institute of Karnataka, Bengaluru, India
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Abstract
Essential monoclonal gammopathy is usually an asymptomatic condition, the characteristics of which have been defined over approximately 70 years of study. It has a known population-attributable risk of undergoing clonal evolution to a progressive, symptomatic B-cell neoplasm. In a very small fraction of patients, the monoclonal immunoglobulin has biophysical characteristics that can lead to tissue deposition syndrome (e.g. Fanconi renal syndrome) or, by chance, have characteristics of an autoantibody that may inactivate critical proteins (e.g. acquired von Willebrand disease). In this report, we describe the very uncommon forms of ocular injury that may accompany essential monoclonal gammopathy, which include crystalline keratopathy, crystal-storing histiocytosis, hypercupremic keratopathy, and maculopathy. The first three syndromes result from uncommon physicochemical alterations of the monoclonal immunoglobulin that favor crystallization or exaggerated copper binding. The last-mentioned syndrome is of uncertain pathogenesis. These syndromes may result in decreased visual acuity. These ocular findings may lead, also, to the diagnosis of monoclonal gammopathy.
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Affiliation(s)
- Sophia R. Balderman
- Instructor in Medicine, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Marshall A. Lichtman
- Professor of Medicine and of Biochemistry and Biophysics, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
- To whom correspondence should be addressed. E-mail:
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