title: Serous macular detachment in Waldenström macroglobulinemia: a report of four cases.
abstract: OBJECTIVE
  To describe a series of 4 patients with Waldenström macroglobulinemia and serous macular detachment, and propose a mechanism for development of subretinal fluid based on optical coherence tomography (OCT) findings.
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  The records of patients with Waldenström macroglobulinemia and OCT documentation of serous macular detachment at Wills Eye Institute were reviewed. Data collection included clinical examination, as well as findings on fluorescein angiography (FA) and OCT.
  
  
  RESULTS
  Four patients (8 eyes) with Waldenström macroglobulinemia and serous retinal detachment were identified. All eyes had varying degrees of venous stasis retinopathy and intraretinal edema overlying the macular detachment. Three patients had no FA leakage, while 1 patient had macular leakage in a petaloid pattern. Focal outer retinal defects within the detached retina were seen in 4 eyes on OCT imaging. In one eye, development of cystoid macular edema was observed before the outer retinal defect and serous macular detachment. All patients with serous macular detachment had some degree of outer retinal disruption.
  
  
  CONCLUSIONS
  Discontinuity of the outer retina within the macular detachment may enable immunoglobulins along with accumulated intraretinal fluid to flow into the subretinal space, creating a serous retinal detachment. Even with systemic treatment of the underlying Waldenström macroglobulinemia, the visual prognosis was guarded.
authors.affiliation: Retina Service, Wills Eye Institute at Thomas Jefferson University, Philadelphia, PA, USA. pbakerny@yahoo.com
authors.forename: Paul S
authors.initials: PS
authors.lastname: Baker
authors.forename: Sunir J
authors.initials: SJ
authors.lastname: Garg
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Fineman
authors.forename: Allen
authors.initials: A
authors.lastname: Chiang
authors.forename: Rayan A
authors.initials: RA
authors.lastname: Alshareef
authors.forename: Jonathan
authors.initials: J
authors.lastname: Belmont
authors.forename: Gary C
authors.initials: GC
authors.lastname: Brown
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D001809:Blood Viscosity; D002199:Capillary Permeability; D004359:Drug Therapy, Combination; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008269:Macular Edema / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012163:Retinal Detachment / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D044967:Serum; D058471:Subretinal Fluid; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D008258:Waldenstrom Macroglobulinemia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy
chemical_list: D005938:Glucocorticoids