A Case with Bilateral Central Retinal Vein Occlusion as the Initial Finding of Multiple Myeloma: Documentation of Long-term Retinal Alterations and a Literature Review

Abstract

51-year-old male patient with no remarkable medical history presented with blurred vision in both eyes. Best corrected visual acuity (BCVA) was 1.0 OU. Fundus evaluation revealed bilateral central retinal vein occlusion with no ischemia on fluorescein angiography. Optical coherence tomography (OCT) showed irregularities on outer plexiform/outer nuclear layer and intraretinal cysts mainly in the outer nuclear layer. Blood tests revealed severe anemia and high sedimentation rate. Serum immunofixation electrophoresis and bone marrow biopsy results were consistent with multiple myeloma diagnosis. The patient was referred for chemotherapy. The patient was reevaluated 3.5 years after the diagnosis. BCVA was 1.0 OU, fundus evaluation showed the resolution of retinal hemorrhages, venous tortuosity and dilation except for irregularities in outer plexiform/outer nuclear layers on OCT. Retinopathy might be the initial finding in hyperviscosity syndrome. Timely diagnosis and management would be sight and life-saving, therefore ophthalmologists should determine hyperviscosity syndrome in the differential diagnosis of bilateral central retinal vein occlusion. Some structural retinal alterations might persist despite successful systemic treatment.