Optical coherence tomography angiography characteristics in Waldenström macroglobulinemia retinopathy:A case report

• 作者: Feng Gu Jun Li Peng Sun Rui Zhang Zhe-Li Liu
• 来源期刊: 世界临床病例杂志
• 学科: 医学
• 关键词: Waldenström macroglobulinemia Retinal vein occlusion RANIBIZUMAB Optical coherence tomography angiography OPHTHALMOLOGY Case report
• 年，卷（期）: sjlcblzz_2020,（23）
• 页码范围: 6071-6079
• 页数: 9页
• 分类号: R73

摘要

BACKGROUND Waldenström macroglobulinemia(WM)is a distinct clinicopathologic entity characterized by the infiltration of the bone marrow by clonal lymphoplasmacytic cells that produce monoclonal immunoglobulin M(IgM)in the blood,and patients may present with symptoms related to the infiltration of the hematopoietic tissues or the effects of monoclonal IgM in the blood.Funduscopic abnormalities were noted in some of the patients due to hyperviscosity or other retinal lesions.Optical coherence tomography angiography(OCTA)as a noninvasive imaging tool can give qualitative and quantitative information about the status of retinal and choroidal vessels,which might be useful for diagnosing patients with WM-associated retinopathy.CASE SUMMARY The patient was a 67-year-old man who presented with sudden visual disturbance in both eyes.Ophthalmic tests showed that best corrected visual acuity(BCVA)for this patient was 20/100 in the right eye and 20/1000 in the left eye.Fundus examination,optical coherence tomography(OCT),and OCTA revealed substantial bilateral optic disc edema,dilated and tortuous retinal veins,and diffuse intraretinal blot hemorrhages and edema which were consistent with bilateral central retinal vein occlusion(CRVO).Meanwhile,remarkable bilateral serous macular detachments(SMD)were noticed on OCT.Systemic examinations showed that the patient had anemia and extremely high level of monoclonal IgM and infiltration of clonal lymphoplasmacytic cells in bone marrow.The diagnosis of WM with hyperviscosity and retinopathy was made based on the clinical manifestation and laboratory findings.He was subsequently treated with intravitreal ranibizumab injection,plasmapheresis,and bortezomib plus rituximab with dexamethasone.Six months after treatments,the central macular volume decreased by 16.1%in the right eye and 28.6%in the left eye on OCT,and the patient’s BCVA was improved to 20/60 in the right eye and 20/400 in the left eye.Very good partial response was obtained after systemic treatment.CONCLUSION WM may aff