Reversal of Retinopathy in Waldenström's Macroglobulinemia by Plasmapheresis

Abstract

Macroglobulinemia of Waldenström is a disease of the reticuloendothelial system in which there is marked elevation of serum proteins with molecular weights of 600,000 to 1,000,000.² The typical ophthalmological findings include sludging of the blood flow in the conjunctival vessels,³ marked distention and tortuosity of the retinal veins, multiple retinal hemorrhages, and occasionally, papilledema.^4-7 The more severe cases may resemble central retinal vein occlusion in both eyes. In several cases, keratoconjunctivitis sicca^8,9 and secondary glaucoma⁴ have been noted. Spalter, in a recent review of macroglobulinemia with special emphasis on the fundus findings, has postulated that the increased serum viscosity is of primary importance in the pathogenesis of the retinopathy.¹⁰ The purpose of this report is to describe the reversal of the retinopathy in two patients with Waldenström's macroglobulinemia by intensive plasmapheresis. These observations seem to confirm the importance of the elevated serum macroglobulin and