Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California.
Retin Cases Brief Rep. 2022 Sep 1;16(5):565-568. doi: 10.1097/ICB.0000000000001056.
To describe the multimodal imaging findings of cystoid macular edema (CME) in POEMS syndrome and to demonstrate the effectiveness of the dexamethasone intravitreal implant in this condition.
A case report of a patient with POEMS syndrome. Multimodal imaging, including optical coherence tomography and ultra-wide field fluorescein angiography, was used to evaluate the CME and its response to treatment.
A 66-year-old man with a history of POEMS syndrome in clinical remission after chemotherapy presented with blurry vision in the left eye. Vitreomacular traction and CME were noted on optical coherence tomography. After pars plana vitrectomy, the patient had persistent CME in the left eye and developed new CME in the right eye, which worsened over the next year. Visual acuities at this time were 20 of 60 in both eyes. The CME was unresponsive to topical ketorolac and prednisolone acetate and intravitreal bevacizumab but partially response to intravitreal and sub-Tenon's triamcinolone acetate injections. Intravitreal dexamethasone implant was given bilaterally with full resolution and visual acuities improvement to 20 of 40 in the right eye and 20 of 30 in the left eye. However, CME recurred after 3 months. Ultra-wide field fluorescein angiography demonstrated bilateral CME and diffuse peripheral vascular leakage. Serum vascular endothelial growth factor levels were normal.
Cystoid macular edema may develop in POEMS syndrome in the absence of systemic findings, elevated serum vascular endothelial growth factor, or optic nerve edema. Previously unreported peripheral vascular leakage was demonstrated on ultra-wide field fluorescein angiography. Dexamethasone implant was the most effective of used therapies to treat CME.
描述 POEMS 综合征中囊样黄斑水肿（CME）的多模态成像表现，并展示地塞米松眼内植入物在该病症中的治疗效果。
报告 1 例 POEMS 综合征患者。采用包括光相干断层扫描和超广角荧光素血管造影在内的多模态成像来评估 CME 及其对治疗的反应。
1 例 66 岁男性，曾患有 POEMS 综合征，经化疗后处于临床缓解期，现因左眼视力模糊就诊。光相干断层扫描显示存在玻璃体黄斑牵引和 CME。行玻璃体切除术联合硅油填充后，患者左眼 CME 持续存在，并在接下来的 1 年内右眼出现新的 CME，且病情逐渐加重。此时双眼视力均为 20/60。CME 对局部用酮咯酸和醋酸泼尼松龙及玻璃体腔内贝伐单抗均无反应，但对玻璃体腔内和经Tenon 囊下曲安奈德注射有部分反应。双侧玻璃体腔内给予地塞米松植入物后，完全缓解，右眼视力提高至 20/40，左眼视力提高至 20/30。然而，3 个月后 CME 再次复发。超广角荧光素血管造影显示双侧 CME 和弥漫性周边血管渗漏。血清血管内皮生长因子水平正常。
在无全身表现、血清血管内皮生长因子升高或视神经水肿的情况下，POEMS 综合征可能会发生 CME。在超广角荧光素血管造影上显示出以前未报道过的周边血管渗漏。地塞米松植入物是治疗 CME 最有效的方法之一。
