Immunogammopathies and acquired vitelliform detachments: a report of four cases.

Irene M Rusu, Sarah Mrejen, Michael Engelbert, Roberto Gallego-Pinazo, Michael D Ober, Mark W Johnson, Anita Leys, Lawrence A Yannuzzi

Journal: American journal of ophthalmology 2014;157(3):648-57.e1

PMID: 24321469

Full Text on Elsevier Science View on PubMed

Abstract

PURPOSE

To describe the nature and evolution of acquired macular detachments in patients with immunogammopathies and to propose a mechanism for their development.

DESIGN

Retrospective observational case series.

METHODS

Three patients with multiple myeloma and 1 with light chain deposition disease were diagnosed with vitelliform macular detachments based on clinical examination, fundus autofluorescence, fluorescein angiography, and optical coherence tomography. These patients were followed over time and their clinical examinations and imaging studies were compared and contrasted.

RESULTS

Three patients (5 eyes) with multiple myeloma and 1 patient (2 eyes) with light chain deposition disease presented with acquired macular yellowish subretinal deposits on funduscopic examination that corresponded to hyperautofluorescent lesions on fundus autofluorescence imaging and subretinal hyperreflective material on spectral-domain optical coherence tomography. One patient (2 eyes) had diffuse serous retinal detachments involving not only the macular region but also the midperiphery of the retina. These acquired macular vitelliform detachments were not associated with signs of hyperviscosity retinopathy in 5 eyes and resolved after successful treatment of the multiple myeloma in 6 eyes.

CONCLUSION

Patients with an immunogammopathy such as multiple myeloma or light chain deposition disease may develop serous elevations of the macula that we classify as acquired vitelliform detachments using multimodal imaging. Appropriate evaluation including serum protein electrophoresis and hematology consultation should be considered in the management of patients with acquired vitelliform detachments of uncertain etiology.

Address: Department of Ophthalmology, New York University School of Medicine, New York, New York.; Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital-Northshore Long Island Jewish Hospital, New York, New York.; Department of Ophthalmology, New York University School of Medicine, New York, New York; Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital-Northshore Long Island Jewish Hospital, New York, New York; Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York.; Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain.; Retina Consultants of Michigan, Southfield, Michigan.; Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.; University Hospitals Leuven, Leuven, Belgium.; Department of Ophthalmology, New York University School of Medicine, New York, New York; Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital-Northshore Long Island Jewish Hospital, New York, New York; Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: [email protected].

DOI: 10.1016/j.ajo.2013.11.020

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MeSH Terms: Female, Fluorescein Angiography, Humans, Immunoglobulin Light Chains, Male, Middle Aged, Multiple Myeloma, Paraproteinemias, Retinal Detachment, Retrospective Studies, Tomography, Optical Coherence, Visual Acuity