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Bilateral Refractory Neurosensory Retinal and Pigment Epithelial Detachments

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

An 88-year-old woman presented with persistent subretinal fluid (SRF) and enlarging pigment epithelial detachments (PEDs) in each eye following 32 near monthly injections of anti–vascular endothelial growth factor (VEGF). Ocular history included presumed exudative age-related macular degeneration. Central serous chorioretinopathy was also suspected secondary to the presence of yellow subretinal deposits located within an inferior macular detachment in the right eye.

Visual acuity was 20/40 OD and 20/25 OS. She had pseudophakia with an otherwise normal anterior segment examination in each eye. Fundus examination was remarkable for macular PEDs and SRF in each eye. There was an epiretinal membrane in the left eye.

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An 88-year-old woman presented with persistent subretinal fluid (SRF) and enlarging pigment epithelial detachments (PEDs) in each eye following 32 near monthly injections of anti–vascular endothelial growth factor (VEGF). Ocular history included presumed exudative age-related macular degeneration. Central serous chorioretinopathy was also suspected secondary to the presence of yellow subretinal deposits located within an inferior macular detachment in the right eye.

Visual acuity was 20/40 OD and 20/25 OS. She had pseudophakia with an otherwise normal anterior segment examination in each eye. Fundus examination was remarkable for macular PEDs and SRF in each eye. There was an epiretinal membrane in the left eye.

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Article Information

Corresponding Author: Odette M. Houghton, MD, Department of Ophthalmology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (houghton.odette@mayo.edu).

Published Online: May 19, 2022. doi:10.1001/jamaophthalmol.2022.0275

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
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Ho  M , Patel  A , Goh  CY , Moscvin  M , Zhang  L , Bianchi  G .  Changing paradigms in diagnosis and treatment of monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM).   Leukemia. 2020;34(12):3111-3125. doi:10.1038/s41375-020-01051-xPubMedGoogle ScholarCrossref
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Orellana  J , Friedman  AH .  Ocular manifestations of multiple myeloma, Waldenström’s macroglobulinemia and benign monoclonal gammopathy.   Surv Ophthalmol. 1981;26(3):157-169. doi:10.1016/0039-6257(81)90065-5PubMedGoogle ScholarCrossref
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Smith  SJ , Johnson  MW , Ober  MD , Comer  GM , Smith  BD .  Maculopathy in patients with monoclonal gammopathy of undetermined significance.   Ophthalmol Retina. 2020;4(3):300-309. doi:10.1016/j.oret.2019.09.018PubMedGoogle ScholarCrossref
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Cohen  SM , Kokame  GT , Gass  JD .  Paraproteinemias associated with serous detachments of the retinal pigment epithelium and neurosensory retina.   Retina. 1996;16(6):467-473. doi:10.1097/00006982-199616060-00001PubMedGoogle ScholarCrossref
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Ho  AC , Benson  WE , Wong  J .  Unusual immunogammopathy maculopathy.   Ophthalmology. 2000;107(6):1099-1103. doi:10.1016/S0161-6420(00)00118-4PubMedGoogle ScholarCrossref
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Rusu  IM , Mrejen  S , Engelbert  M ,  et al.  Immunogammopathies and acquired vitelliform detachments: a report of four cases.   Am J Ophthalmol. 2014;157(3):648-57.e1. doi:10.1016/j.ajo.2013.11.020PubMedGoogle ScholarCrossref
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Grannis  CH , Dewan  VN , Wang  RC .  Resolution of bilateral cystoid macular edema and subfoveal serous retinal detachments after treatment with bortezomib in a patient with “smoldering” multiple myeloma.   Retin Cases Brief Rep. 2014;8(4):348-351. doi:10.1097/ICB.0000000000000067PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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