This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Citing articles on ISI (1)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Retinal/ Chorioretinal Disorders  • Hematology/ Hematologic Malignancies  • Hematology, Other  • Alert me on articles by topic

Marcel N. Menke, MD; Gilbert T. Feke, PhD; J. Wallace McMeel, MD; Andrew Branagan, BS; Zachary Hunter, BS; Steven P. Treon, MD, PhD

Arch Ophthalmol. 2006;124:1601-1606.

Objectives  To determine the earliest retinal changes associated with Waldenström macroglobulinemia (WM) and to ascertain the serum IgM and serum viscosity (SV) levels at which these changes occur.

Methods  Patients with WM were evaluated using indirect ophthalmoscopy with scleral depression, laser Doppler retinal blood flow measurements, and serum IgM and SV determinations. Hemodynamic findings were compared with those of a group of age-matched controls. A retinopathy severity scale was developed, and the associated IgM and SV values were related to particular morphologic changes.

Results  A total of 46 patients with WM and 14 age-matched, healthy controls participated in the study. Patients exhibited far-peripheral hemorrhages and venous dilation with increasing SV and IgM values. Central retinal changes were associated with significantly higher SV values. Retinal vessel diameter increased with increasing serum IgM and SV levels. The mean IgM level of patients with the earliest retinal changes was 5442 mg/dL. The mean SV level was 3.1 cP.

Conclusions  Retinal manifestations of hyperviscosity syndrome occur at lower serum IgM and SV levels than previously reported. Indirect ophthalmoscopy with scleral depression along with retinal vessel diameter measurements are able to detect the earliest hyperviscosity syndrome–related complications and should be considered in the treatment of patients with WM.

Author Affiliations: Schepens Retina Associates Foundation (Drs Menke, Feke, and McMeel); Bing Program for Waldenström's Macroglobulinemia, Dana Farber Cancer Institute (Messrs Branagan and Hunter and Dr Treon); and Division of Ophthalmology, Departments of Surgery (Drs Menke and Feke) and Ophthalmology (Dr McMeel), and Department of Medicine (Dr Treon and Messrs Branagan and Hunter), Harvard Medical School, Boston, Mass. Dr Menke is currently with the Department of Ophthalmology, University of Leipzig, Leipzig, Germany.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Effect of Plasmapheresis on Hyperviscosity-Related Retinopathy and Retinal Hemodynamics in Patients with Waldenstrom's Macroglobulinemia
Menke et al.
IOVS 2008;49:1157-1160.
ABSTRACT | FULL TEXT