First Author: A.Rey SPAIN
Co Author(s): A. Dyrda X. Maseras I. Jurgens
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To describe an unusual finding in a patient with Waldenström’s disease who presented with a pseudovitelliform deposit and macular edema.
Institut Catala de Retina, Barcelona
A 75-year-old asymptomatic male with Waldeström´s disease was referred to a routine ophthalmologic examination. His visual acuity was 20/20 in both eyes. No inflammation was observed in the anterior chamber or vitreous. Fundus examination showed a yellowish subfoveal deposit in his right eye and peripheral haemorrhages in both eyes. optical coherence tomography (OCT) disclosed a macular edema and a hyperreflective subfoveal deposit in his right eye.
Macular autofluorescence didn’t show any hyperautofluorescence of the yellowish material. Fluorescein angiography (FA) disclosed on the temporal retinal periphery a focal area of capillary non-perfusion associated with microaneurysms and retinal haemorrhages in both eyes, and mild retinal pigment epithelium mottling in his right eye. Pseudovitelliform deposits usually consist of debris, including lipofuscin, melanoliposfuscin granules in the retinal pigment epithelium and in macrophages, and extracellular material derived from photoreceptor outer segment discs. Such deposits are usually hyperautofluorescent. In our patient, however, the deposit may have a different composition, since they were hypoautofluorescent. They may correspond to an accumulation of subretinal macroglobulins.
Although the incidence of the disease is rare, meticulous examination of the retinal periphery and macula should be performed in all patients with Waldenström’s disease. Differential diagnosis of peripheral retinal non-perfusion and macular edema should include asymptomatic Waldenström’s macroglobulinemia.