First Author: J.Costa PORTUGAL
Co Author(s): P. Brito G. Calvo Santos F. Vaz
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Multiple myeloma (MM) is a disease characterized by an erroneous proliferation of plasma cells from a single clone in the bone marrow. It is the second most common haematologic malignancy and the tumour, its products and the host response result can produce a vast range of symptoms and organ dysfunctions. Although ophthalmic findings are variable and diverse, they are also rare. There have been some reports of macular edema in these patients. We report the unusual case of a unilateral serous retinal detachment in a patient with MM, which required intravitral treatment with bevacizumab.
Case Report of a patient diagnosed and treated at the Ophthalmology Department of Hospital de Braga, Braga, Portugal
A 60-year-old male presented with gradual loss of visual acuity in the left eye, during the preceding last five months. He had recently been diagnosed with MM and initied systemic chemotherapy with bortezomib, thalidomide, and dexamethasone. Spectral-domain optical coherence tomography (SD-OCT) was obtained on presentation and follow-up, as well as fluorescein angiography.
On presentation the patient had best corrected visual acuity of 20/40 on the left eye and fundoscopy showed loss of foveal reflex suggesting retinal edema. SD-OCT revealed a central foveal thickness of 436 µm, with extensive subretinal fluid (212 µm subfoveal vertical height) and macular volume of 9.65mm3. Fluorescein angiography revealed only slightly increased central macular hypofluorescence due to blocking effect by subretinal fluid. By the 5th chemotherapy cycle, the M component was reduced from 66g/L to 5g/L, the ratio of the urinary light chains kappa/lambda was normalized and the proteinuria was gone. However, the patient maintained retinal detachment and diminished visual acuity. Therefore, it was decided to start treatment with intravitreal bevacizumab. At that moment, the patient initiated treatment with monthly intravitreal injections of 1.25mg bevacizumab. After only two treatments central foveal thickness reduced to 315 µm and macular volume to 8.95 mm3 and visual acuity was maintained.
Ophthalmic manifestations of MM are rare but diverse, being macular edema one of them. In none of the few published cases, specific treatment for macular edema was tried, with resolution of this comorbidity with three months of systemic chemotherapy alone. In our patient, the addition of intravitreal bevacizumab after 4 of systemic treatment, led to significant tomographic improvement and clinical stabilization of macular edema.