- Ophthalmic Surgery, Lasers and Imaging
A 12-year-old girl with a 3-month history of epistaxis and Castleman’s disease presented with blurred vision in both eyes for 2 weeks. Indirect ophthalmoscopy revealed a blurred optic disc margin, venous engorgement and tortuosity, intraretinal hemorrhages and cotton wool spots, and serous detachment of the neurosensory retina in the posterior pole of each eye. Fluorescein angiography and laboratory tests revealed abnormalities consistent with the clinical examination. Six months following institution of immunosuppressive treatment, cryoglobulin levels decreased and visual acuity and funduscopic abnormalities were markedly improved. However, a few microaneurysms, retinal hemorrhages, and venous engorgement and tortuosity persisted. One month after the cessation of immunosuppressive treatment, symptoms related to the hyperviscosity syndrome recurred and the patient was treated with one session of plasmapheresis. One month after the plasmapheresis, the patient’s symptoms resolved, laboratory values were normal, visual acuity was 20/15 in both eyes, and the funduscopic examination of each eye was unremarkable.
From the Retina and Vitreous Service–Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery (RJ, RCO, RAC, RCS), Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; the Departments of Ophthalmology and Public Health Sciences (IUS), Penn State College of Medicine, Hershey, Pennsylvania; the Division of Clinical Immunology–Department of Internal Medicine (PL-J), Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; and the Department of Medicine (RCO), Federal University of Rondônia, Porto Velho, Rondônia, Brazil.
The authors have no financial or proprietary interest in the materials presented herein.
Address correspondence to Rafael C. Oliveira, MD, PhD, School of Medicine, Federal University of Rondônia, Av. Calama, Porto Velho, Rondônia, Brazil, 2264 Cep: 78900-000. E-mail: firstname.lastname@example.org