JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2016.57.6.1012 jkos-57-1012 Case Report Bilateral Simultaneous Central Retinal Vein Occlusion in a Patient with Waldenstrom's Macroglobulinemia LeeSang Eon MD ShinYong Un MD LimHan Woong MD SeongMin Chul MD ChoHee Yoon MD KangMin Ho MD Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea Address reprint requests to Min Ho Kang, MD Department of Ophthalmology, Hanyang University Guri Hospital, #153 Gyeongchun-ro, Guri 11923, Korea Tel: 82-31-560-2350, Fax: 82-31-564-9479 E-mail: ocularimmunity@gmail.com 09 2016 25 09 2016 576 1012 1017 10072015 19092015 14112015 Copyright © 2016 Korean Ophthalmological Society 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

The authors report a case of bilateral simultaneous central retinal vein occlusion caused by Waldenstrom's macroglobulinemia.

 Case summary

A 65-year-old man presented to our department complaining of decreased visual acuity for the duration of about 6 months. On his initial visit, best-corrected visual acuity was 0.02 in the right eye and 0.06 in the left eye. Based on the findings of a funduscopic examination, the patient had bilateral diffuse retinal hemorrhages, dilated tortuous veins, and macular edema. He had experienced recurrent spontaneous epistaxis 6 months previously and had undergone treatments such as intravitreal bevacizumab injection and intravitreal dexamethasone implantation at another hospital. Laboratory tests at that hospital showed anemia and hyperproteinemia, for which he was referred to our hemato-oncology department. Bone marrow biopsy was consistent with Waldenstrom's macroglobulinemia/lymphoplasmacytoid lymphoma, and he was treated with systemic chemotherapy. One year after the systemic chemotherapy, his best-corrected visual acuity was 0.15 in the right eye and 0.6 in the left eye. Funduscopy showed decreased bilateral retinal hemorrhages and macular edema.

 Conclusions

When simultaneous bilateral central retinal vein occlusion occurs in a patient with no other underlying disease such as hypertension or diabetes, it might be a sign of serum hyperviscosity, and there should be a very high level of suspicion for presence or progression of systemic disease. If such a disease is properly and timely diagnosed, effective early systemic evaluation and therapy can be administered, and it is important to have initial general treatment as well as ophthalmic treatment.

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Fundus photographs when his first visit. Fundus photographs show dilated tortuous veins, diffuse retinal hemorrhages in all quadrants and vascular sheathing in the right eye (A) and left eye (B).

Optical coherence tomography (OCT) finding when his first visit. OCT shows macular edema in the both eyes and more severe subretinal fluid in the right eye (A) than in the left eye (B). OD = oculus dexter; OS = oculus sinister; R = right; L = left; ILM = internal limiting membrane; RPE = retinal pigment epithelium; ETDRS = Early Treatment Diabetic Retinopathy Study; S = superior; N = nasal; I = inferior; T = temporal.

Fundus photographs after the systemic chemotherapy. Fundus photographs show decreased dilated tortuous veins and retinal hemorrhages in the both eyes and decreased vascular sheathing in the right eye. There are few changes between 3 months (A, B) and 1 year (C, D).

Optical coherence tomography (OCT) finding after the systemic chemotherapy. OCT shows decreased subretinal fluid and macular edema in the right eye (A) and the left eye (B). But, subretinal fluid and macular edema still remains. Subretinal fibrin accumulation or choroid neovascularization are not detected due to serous retinal detachment. OCT shows atrophy of the retinal pigment epithelium on the macula and decrease in outer neuroretina layer thickness. OD = oculus dexter; OS = oculus sinister; R = right; L = left; T = temporal; N = nasal; S = superior.