Hyperviscosity Retinopathy and Immunogammopathy Maculopahy as New Onset of Multiple Myeloma

The purpose is to report a case of immunogammopathy maculopathy and hyperviscosity retinopathy as the presenting feature of new-onset multiple myeloma (MM) in an otherwise healthy man. A 50-years-old man presented with painless visual changes in both eyes for 2 months. Ocular examination revealed bilateral CRVO-like associated with macular edema (ME) and an inferior serous detachment. Hematologic investigation revealed an increased percentage of plasma cells in the bone marrow, reaching the diagnosis of MM IgM/kappa. Clinical support and chemotherapy effectively improved ocular alterations, despite the residual ME. Injection of triamcinolone was carried out, without any response. Bilateral vision reduction with hyperviscosity syndrome-related retinopathy and immunogammopathy maculopathy was the first manifestation of an underlying systemic and potentially fatal disease. This case highlights the need for diligent and thorough investigations for less common systemic conditions associated with retinal vein occlusions.

Intraocular pressure modifications in patients with acute central/hemicentral retinal vein occlusions

Intraocular pressure (IOP) modifications in patients with acute central/hemicentral retinal vein occlusions (RVOs) consist in IOP reductions and increases. The IOP reduction is due to a transitional hyposecretory phase of the aqueous humor, that increases gradually until 3mo after the venous occlusion onset, and then finally disappears after month 4th. The IOP increases lead to the ocular hypertension and glaucoma. The possible pathogenetic correlations between ocular hypertension/glaucoma and acute central/hemicentral RVOs have been classified into three groups: 1) the venous occlusion precedes the ocular hypertension/glaucoma causing neovascular glaucoma and secondary angle-closure glaucoma without rubeosis; 2) the ocular hypertension and the glaucoma precede the venous occlusion and favor its appearance (ocular hypertension, primary angle-closure, primary angle-closure glaucoma, and open angle glaucomas); and 3) the venous occlusion and the ocular hypertension/glaucoma are mostly age dependent appearances due to common vascular and collagen alterations, lacking a causal connection between the 2 conditions.

Central Retinal Vein Occlusion Secondary to Ocular Trauma in a Young Patient

Central retinal vein occlusions (CRVO) occurring in young patients or due to a traumatic etiology is uncommon. This paper outlines the case of a 33-year-old Asian male who presented with a chief complaint of blurry peripheral vision and photophobia in his left eye, one week after sustaining blunt ocular trauma. He was diagnosed with a traumatic CRVO based on history and exam findings.

Macular edema after retinal vein occlusions. Macular morphometry and chorioretinal hemodynamics

This review article summarizes current data on the pathogenesis of macular edema after retinal vein occlusions (RVOs) and patterns of macular morphometry and chorioretinal hemodynamics. RVOs account for 60% of acute vascular eye diseases. The major cause of vision loss in RVOs is macular edema which results from subclinical inflammation characterized by leukostasis and enhanced expression of adhesion molecules and production of cytokines increasing retinal capillary permeability. The association between the severity of macular edema and vitreous levels of pro-inflammatory mediators (IL-1β, IL-6, TNF-α, MCP-1, and VEGF) is established. Cystic lesions and detachment of the neuroepithelium (75%) are typical for macular edema after RVOs. Impaired chorioretinal hemodynamics (as demonstrated by a significant reduction of vascular density in the superficial and deep vascular plexus, significant decrease in peak diastolic flow velocity, and increase in resistivity index in the ophthalmic artery and short posterior ciliary arteries) is also reported. The paper addresses etiological factors of RVOs and pathogenesis of macular edema, technical tools for vital assessment of the retina, and choroidal/retinal hemodynamics. This provides great opportunities for a complex in-depth study of the development and course of macular edema to identify potential predictors of its development and persistence. Keywords: retinal vein occlusions, macular edema, morphometry, chorioretinal hemodynamics. For citation: Fil' A.A., Sorokin E.L., Kolenko O.V. Macular edema after retinal vein occlusions. Macular morphometry and chorioretinal hemodynamics. Russian Journal of Clinical Ophthalmology. 2021;21(3):164–168 (in Russ.). DOI: 10.32364/2311-7729-2021-21-3- 164-168.