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Ophthalmology

Subretinal Deposits Associated With Type 1 Cryoglobulinemia

To identify the key insights or developments described in this article

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JAMA Ophthalmology

Published Online: May 18, 2023

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Article Information and Disclosures

Huan Chen, MD^1,2;

Yang Zhang, MD^1,2;

Rongping Dai, MD^1,2

Author Affiliations

¹Peking Union Medical College Hospital, Department of Ophthalmology, Chinese Academy of Medical Sciences, Beijing, China
²Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China

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A 30-year-old female complained of blurred vision in the right eye. One month ago, she was admitted to the hospital for type 1 cryoglobulinemia with high IgG lambda, acute kidney injury, and hypertension. Her corrected visual acuity was 20/80 OD and 20/20 OS. Ophthalmoscopic examination in both eyes revealed multiple subretinal yellowish lesions (Figure, A, white arrowheads), which presented as moderate-reflection deposits above the retinal pigment epithelium (RPE) on swept-source (SS) optical coherence tomography (OCT) (Figure, B, white arrowheads). SS-OCT also revealed neurosensory detachment and cystoid macular edema with disruption of the external limiting membrane (Figure, B, blue arrowheads). The deposits were associated with monoclonal immunoglobulins or their components leaked from blood vessels and appeared to accumulate above the RPE, potentially analogous to their deposition in the glomeruli and tubulointerstitium.¹^,2 The patient continued to receive chemotherapy. Three weeks later, her vision improved to 20/20 OU, and the deposits and macular edema resolved completely (Figure, A and B, inset).

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Article Information

Corresponding Author: Rongping Dai, MD, Peking Union Medical College Hospital, Department of Ophthalmology, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Rd, DongCheng District, Beijing 100730, China (derricka@sina.com).

Conflict of Interest Disclosures: None reported.

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

References

Kanzaki G , Okabayashi Y , Nagahama K , et al. Monoclonal immunoglobulin deposition disease and related diseases. J Nippon Med Sch. 2019;86(1):2-9. doi:10.1272/jnms.JNMS.2019_86-1 PubMed Google Scholar Crossref

Bridoux F , Javaugue V , Nasr SH , Leung N . Proliferative glomerulonephritis with monoclonal immunoglobulin deposits: a nephrologist perspective. Nephrol Dial Transplant. 2021;36(2):208-215. doi:10.1093/ndt/gfz176 PubMed Google Scholar Crossref

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 [and Self-Assessment requirements] 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.