Título / Title

SEROUS RETINAL DETACHMENT CAUSED BY WALDESTROM`S MACROGLOBULINEMIA

Introdução / Purpose

Waldestrom`s Macroglobulinemia is a non-Hodgking lymphoplasocytic B-cell lymphoma, which secretes IgM in great amounts causing hyperviscosit syndrome. Ocular manifestations include serous retinal detachment (RD), retinal pigmented epithelium detachment, hemorrhages, retinal vein occlusion, macular edema, deposit of immunoproteins at the córnea and papilledema.

Material e Método / Methods

Consists of a case report of a man, 52 years old, presentes with a central macular serous detachment started two years ago. Initial visual acuity is of 0,1 in right eye and less than 0,05 in the left eye. Angiography revealed macular serous RD and lead to the realization of fast-pulse laser to control macular detachment. There was na improvement of visual acuity after this laser to 0,5 in both eyes.

Resultados / Results

In 2018, patient returns complaining of worse visual acuity (less than 0,05 in both eyes) and with a recidivated retinal detachment. Patient was referred to a hematologist and was given the diagnosis of Waldestrom`s Macroglobulinemia. Started chemotherapy and a new fast-pulse session with improvement of visual acuity to 0,8 in right eye and 0,5 in left eye. Retinal detachment was been solved.

Discussão e Conclusões / Conclusion

Serous RD is a rare manifestation of this syndrome. Angiographyshows no macular leakage and indicates that retinal or choroidal exudation is not the mechanism through which fluid is accumulated under retina. The most accepted theory is that IgM molecules presente in subretinal space rise the osmotic gradient, causing the accumulation of fluid under retina. Treatment with chemotherapy and plasmapheresis can reduce hyperproteinemia, improve serous RD and lead to visual acuity gains as well as found in the case described. However, most of patients persist chronically subretinal fluid and a reserved prognosis.

Palavras Chave

Waldestrom`s Macroglobulinemia; SEROUS RETINAL DETACHMENT