Ogata Nayumi, Ueda Kohei, Aoki Shuichiro
Ophthalmology, Tokyo Teishin Hospital, Tokyo, JPN.
Ophthalmology, University of Tokyo, Tokyo, JPN.
Cureus. 2023 Jul 10;15(7):e41622. doi: 10.7759/cureus.41622. eCollection 2023 Jul.
In Waldenström's Macroglobulinemia (WM), increased immunoglobulin M causes various signs and symptoms. It sometimes presents with macular edema. A 65-year-old WM patient with a five-year history of diabetes mellitus was evaluated for ocular complications. Fundus examination and optical coherence tomography showed retinal changes consistent with non-proliferative diabetic retinopathy and foveal detachment with intraretinal cysts in the right eye, suggesting diabetic macular edema. However, on fluorescein angiography, there was no leakage over the area of foveal detachment, which led to the diagnosis of immunogammopathy maculopathy secondary to WM for macular edema and foveal detachment. The patient's ocular manifestation remained unchanged through a follow-up period of 11 months without therapeutic interventions. Immunogammopathy maculopathy, a rare ocular manifestation of monoclonal gammopathy, demands differentiation from other causes of macular edema in WM patients. The present case highlights the importance of fluorescein angiography, or silent macula, in diabetic patients to distinguish immunogammopathy maculopathy from diabetic macular edema.
在华氏巨球蛋白血症（WM）中，免疫球蛋白M升高会引发各种体征和症状。它有时会表现为黄斑水肿。一名患有5年糖尿病史的65岁WM患者接受了眼部并发症评估。眼底检查和光学相干断层扫描显示，右眼视网膜变化符合非增殖性糖尿病视网膜病变，伴有黄斑脱离及视网膜内囊肿，提示糖尿病性黄斑水肿。然而，荧光素血管造影显示，黄斑脱离区域无渗漏，由此诊断为WM继发免疫球蛋白病性黄斑病变导致黄斑水肿和黄斑脱离。在未经治疗干预的11个月随访期内，患者的眼部表现保持不变。免疫球蛋白病性黄斑病变是单克隆丙种球蛋白病一种罕见的眼部表现，需要与WM患者黄斑水肿的其他病因相鉴别。本病例强调了荧光素血管造影或无症状黄斑在糖尿病患者中对于区分免疫球蛋白病性黄斑病变和糖尿病性黄斑水肿的重要性。
