Title

Immunogammopathies and Acquired Vitelliform Detachments: A Report of Four Cases

Publication Date

2014

Journal Title

Am J Ophthalmol

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 subrefinal 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 consulta-, tion should be considered in the management of patients with acquired vitelliform detachments of uncertain etiology.

Volume Number

157

Issue Number

3

Pages

648-657

Document Type

Article

EPub Date

2013/12/11

Status

Faculty; Northwell Researcher

Facility

School of Medicine; Northwell Health

Primary Department

Ophthalmology

PMID

24321469

DOI

10.1016/j.ajo.2013.11.020