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Cohen SY, Chowers I, Nghiem-Buffet S, Mrejen S, Souied E, Gaudric A. Subretinal autofluorescent deposits: A review and proposal for clinical classification. Surv Ophthalmol 2023; 68:1050-1070. [PMID: 37392968 DOI: 10.1016/j.survophthal.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
Subretinal autofluorescent deposits (SADs) may be found in the posterior pole, associated with very various conditions. These disorders usually present a typical pattern of autofluorescent lesions seen on short-wavelength fundus autofluorescence. We describe SADs according to their putative pathophysiological origin and also according to their clinical pattern, i.e., number, shape, and usual location. Five main putative pathophysiological origins of SADs were identified in disorders associated with an intrinsic impairment of phagocytosis and protein transportation, with excess of retinal pigment epithelium phagocytic capacity, with direct or indirect retinal pigment epithelium injury, and/or disorders associated with long-standing serous retinal detachment with mechanical separation between the retinal pigment epithelium and the photoreceptor outer segments. Clinically, however, they could be classified into eight subclasses of SADs, as observed on fundus autofluorescence as follows: single vitelliform macular lesion, multiple roundish or vitelliform lesions, multiple peripapillary lesions, flecked lesions, leopard-spot lesions, macular patterned lesions, patterned lesions located in the same area as the causal disorder, or nonpatterned lesions. Thus, if multimodal imaging may be required to diagnose the cause of SADs, the proposed classification based on noninvasive, widely available short-wavelength fundus autofluorescence could guide clinicians in making their diagnosis decision tree before considering the use of more invasive tools.
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Affiliation(s)
- Salomon Yves Cohen
- Ophthalmology Center for Imaging and Laser, Paris, France; Department of Ophthalmology, University of Paris-Est Créteil, Créteil, France.
| | - Itay Chowers
- Department of Ophthalmology, Hadassah Hospital, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Sarah Mrejen
- Ophthalmology Center for Imaging and Laser, Paris, France
| | - Eric Souied
- Department of Ophthalmology, University of Paris-Est Créteil, Créteil, France
| | - Alain Gaudric
- Ophthalmology Center for Imaging and Laser, Paris, France; Department of Ophthalmology, AP-HP, Hôpital Lariboisière, Université Paris Cité, Paris, France
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Singh RB, Singhal S, Sinha S, Cho J, Nguyen AXL, Dhingra LS, Kaur S, Sharma V, Agarwal A. Ocular complications of plasma cell dyscrasias. Eur J Ophthalmol 2023; 33:1786-1800. [PMID: 36760117 PMCID: PMC10472748 DOI: 10.1177/11206721231155974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/21/2023] [Indexed: 02/11/2023]
Abstract
Plasma cell dyscrasias are a wide range of severe monoclonal gammopathies caused by pre-malignant or malignant plasma cells that over-secrete an abnormal monoclonal antibody. These disorders are associated with various systemic findings, including ophthalmological disorders. A search of PubMed, EMBASE, Scopus and Cochrane databases was performed in March 2021 to examine evidence pertaining to ocular complications in patients diagnosed with plasma cell dyscrasias. This review outlines the ocular complications associated with smoldering multiple myeloma and monoclonal gammopathy of undetermined significance, plasmacytomas, multiple myeloma, Waldenström's macroglobulinemia, systemic amyloidosis, Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin changes (POEMS) syndrome, and cryoglobulinemia. Although, the pathological mechanisms are not completely elucidated yet, wide-ranging ocular presentations have been identified over the years, evolving both the anterior and posterior segments of the eye. Moreover, the presenting symptoms also help in early diagnosis in asymptomatic patients. Therefore, it is imperative for the treating ophthalmologist and oncologist to maintain a high clinical suspicion for identifying the ophthalmological signs and diagnosing the underlying disease, preventing its progression through efficacious treatment strategies.
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Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Department of Ophthalmology, Great Ormond Street Institute of Child Health, University College London, London, UK
- Discipline of Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Sachi Singhal
- Department of Internal Medicine, Crozer-Chester Medical Center, Upland, PA, USA
| | - Shruti Sinha
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Junsang Cho
- Department of Ophthalmology, Vanderbilt Eye Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Lovedeep Singh Dhingra
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Snimarjot Kaur
- Department of Pediatrics, Yale-New Haven Hospital, New Haven, CT, USA
| | - Vasudha Sharma
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Aniruddha Agarwal
- Department of Ophthalmology, University of Maastricht, Maastricht, the Netherlands
- Department of Ophthalmology, The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Khan S, Premji S, Huang Q, Verstovsek G, Bushan S, Yellapragada SV. An eye-catching atypical illustration of the evaluation and management of AL amyloidosis secondary to myeloma. Clin Case Rep 2021; 9:e05176. [PMID: 34938552 PMCID: PMC8659555 DOI: 10.1002/ccr3.5176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
We present a case of a 58-year-old male patient who presented to his primary care clinic with complaints of eye swelling and fatigue. Workup ultimately led to a diagnosis of AL amyloidosis secondary to myeloma based on SLiM-CRAB criteria. We discuss his diagnostic workup, treatment, and subsequent relapse.
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Affiliation(s)
- Shamis Khan
- Internal MedicineBaylor College of MedicineHoustonTexasUSA
| | - Sarah Premji
- Internal MedicineBaylor College of MedicineHoustonTexasUSA
| | - Quillan Huang
- Hematology and OncologyMichael E DeBakey VA Medical CenterHoustonTexasUSA
- Section of Hematology & OncologyBaylor College of MedicineHoustonTexasUSA
- Baylor College of MedicineDan L Duncan Comprehensive Cancer CenterHoustonTexasUSA
| | | | - Sita Bushan
- Hematology and OncologyMichael E DeBakey VA Medical CenterHoustonTexasUSA
- Section of Hematology & OncologyBaylor College of MedicineHoustonTexasUSA
- Baylor College of MedicineDan L Duncan Comprehensive Cancer CenterHoustonTexasUSA
| | - Sarvari Venkata Yellapragada
- Hematology and OncologyMichael E DeBakey VA Medical CenterHoustonTexasUSA
- Section of Hematology & OncologyBaylor College of MedicineHoustonTexasUSA
- Baylor College of MedicineDan L Duncan Comprehensive Cancer CenterHoustonTexasUSA
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Tsani Z, Ntafos A, Toumanidou V, Dastiridou A, Ploumi I, Androudi S. Vision loss in a pregnant woman with nephrotic syndrome. Eur J Ophthalmol 2021; 33:11206721211054731. [PMID: 34664511 DOI: 10.1177/11206721211054731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report acute visual acuity loss in a pregnant woman with nephrotic syndrome. CASE REPORT A 34-year-old pregnant woman was referred to our service for acute, bilateral visual impairment, associated with bilateral below knee edema (BKE). Best-corrected visual acuity (BCVA) was hand motion in the right eye and 20/200 in the left eye. Dilated fundus exam disclosed multiple pigment epithelium detachments involving the macula in both eyes. After consultation with a nephrologist a diagnosis of nephrotic syndrome was made. Unfortunately, a week later she lost the fetus. At follow-up evaluation, 20 days after the miscarriage, BCVA improved to 20/25 in both eyes with near normal restoration of the retinal anatomy. CONCLUSION In nephrotic syndrome, sequestration of interstitial fluids, which leads to classic generalized edema, could be the origin of interstitial accumulation of fluids in the retinal and subretinal layers. Increased awareness by the gynaecologists and prompt treatment may prevent fetus miscarriage.
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Affiliation(s)
- Zoi Tsani
- Department of Ophthalmology, 393317University of Thessaly, Larissa, Greece
| | - Antonios Ntafos
- Department of Ophthalmology, 393317University of Thessaly, Larissa, Greece
| | | | - Anna Dastiridou
- Department of Ophthalmology, 393317University of Thessaly, Larissa, Greece
| | - Ioanna Ploumi
- 195088Northeastern University, College of Science, Boston, MA, USA
| | - Sofia Androudi
- Department of Ophthalmology, 393317University of Thessaly, Larissa, Greece
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de Amorim Garcia Filho CA, de Oliveira RA, Meirelles RL, Lima LH, Balaratnasingam C, Agarwal A, de Amorim Garcia CA. UNUSUAL CASE OF BILATERAL MACULAR DETACHMENT PRECEDING RENAL FAILURE. Retin Cases Brief Rep 2021; 15:S21-S24. [PMID: 34171898 DOI: 10.1097/icb.0000000000001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | | | - Rodrigo L Meirelles
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Luiz H Lima
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Chandrakumar Balaratnasingam
- Center for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Western Australia, Australia; and
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[Bilateral subretinal fluid and pigmented deposits in a young female patient]. Ophthalmologe 2021; 118:1272-1275. [PMID: 33893530 PMCID: PMC8648706 DOI: 10.1007/s00347-021-01389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 11/15/2022]
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