ABSTRACT
BACKGROUND/PURPOSE: To report an unusual appearance of severe bilateral serous detachments in a patient with Waldenstrom macroglobulinemia. METHODS: A case report of a Fifty-six-year-old female patient with Waldenstrom macroglobulinemia. RESULTS: A patient with Waldenstrom macroglobulinemia presented with serous retinal detachments at the time of diagnosis with Waldenstrom. The patient's IgM levels remained abnormally elevated in the initial stages of her disease course, leading to dramatic ocular findings and images on optical coherence tomography. Chemotherapy was initiated and IgM levels slowly declined, with some improvement in macular fluid as IgM normalized. CONCLUSION: Waldenstrom macroglobulinemia may lead to dramatic retinal pathology if IgM levels remain elevated. Prompt chemotherapy and reduction of immunoglobulin levels should be undertaken to preserve retinal architecture.
Subject(s)
Fluorescein Angiography/methods , Retina/pathology , Retinal Detachment/etiology , Tomography, Optical Coherence/methods , Visual Acuity , Waldenstrom Macroglobulinemia/complications , Female , Fundus Oculi , Humans , Middle Aged , Retinal Detachment/diagnosisABSTRACT
PURPOSE OF REVIEW: Prostaglandin analogs (PGAs) are the most widely used ocular hypotensive medications. Half of the patients with glaucoma and 40% of patients with ocular hypertension require more than one medication to sufficiently lower their intraocular pressures (IOPs). Therefore, it is important to understand the varying efficacy of adjunctive therapies currently available for use in combination with PGAs. RECENT FINDINGS: The IOP-lowering efficacy and safety profiles of various adjunctive treatments continue to be better elucidated, including the nocturnal IOP-lowering efficacy of various medication classes and laser trabeculoplasty. SUMMARY: For patients already on a PGA, the mean diurnal IOP-lowering achieved with the addition of an alpha2 adrenergic agonist, a beta adrenergic antagonist, or a topical carbonic anhydrase inhibitor is similar, whereas the side-effect profiles, nocturnal IOP-lowering efficacy, and trough IOP-lowering effects vary. Laser trabeculoplasty is also an effective means of further lowering the IOP in patients on a PGA.
