COLOR DOPPLER ULTRASOUND INVESTIGATION OF THE THERAPEUTIC EFFECT OF PLASMAPHERESIS ON A LYMPHOPLASMOCYTOID LYMPHOMA (IMMUNOCYTOMA) - A CASEOF CENTRAL RETINAL ARTERY-OCCLUSION

The lymphoplasmocytoid immunocytoma (Waldenstrom's disease) is a non-H odgkin's lymphoma of low malignancy. The disease is defined by the pro duction of monoclonal IgM-globulins in the bone marrow. These macroglo bulins affect the aggregation of thrombocytes and bind the coagulation factors, which leads not only to hemorrhagical diathesis, but also to hyperviscosity syndrome. We present the rare case of a 79-year-old wo man suffering from an immunocytoma with sudden painless loss of vision in her right eye. Ophthalmoscopic examination revealed an occlusion o f the central retinal artery. The immediately performed blood examinat ion showed the following results: IgM serum level was 6610 mg/dl (norm al range: 60-370 mg/dl), kappa-paraproteinemia showed values of 702 mg /dl (normal range: 200-440 mg/dl), and the plasma viscosity was 3.4 mP a/s (normal range: 1.5-1.72 mPa/s). Plasmapheresis was promptly initia ted. Subsequently, the highly pathological serum levels were markedly lower and sight improved from complete amaurosis to qualitative vision . Blood-flow velocity and vascular resistance parameters (resistive in dex) in all nutritious vessels [ophthalmic artery (OA), posterior cili ar arteries (PCA) and central retinal artery (CRA)] were recorded befo re and after each of the six cycles of plasmapheresis, using color Dop pler velocity (CDV). It was proven that even after the first plasmaphe resis, circulation in the central retinal artery was restored. After e ach further cycle of plasmapheresis, an improvement in blood-flow velo city in OA, PCA, and CRA was recorded by CDV. CDV verifies variations in circulation of the eye vessels and gives an objective assessment of the influence of therapy.