PARAPROTEINEMIAS ASSOCIATED WITH SEROUS DETACHMENTS OF THE RETINAL-PIGMENT EPITHELIUM AND NEUROSENSORY RETINA

Background: Serous retinal and retinal pigment epithelial detachments resembling central serous chorioretinopathy developed in three patient s who had paraproteinemias. Methods: The patients in this study were e xamined at two institutions, and their charts, photographs, and fluore scein angiograms were reviewed by the authors. Two patients had cryogl obulinemia and one had IgA, IgM benign gammopathy. Results: These pati ents had decreased central visual acuity and metamorphopsia at the ini tial examination. All three patients were women, Two patients were tak ing systemic corticosteroids in tapering doses at the time of the init ial examination. The multiple serous retinal pigment epithelial and re tinal detachments were unilateral in one patient and bilateral in two patients. Two patients were treated with laser photocoagulation becaus e of chronic visual loss and foveal detachments. At the most recent ex amination, each patient had visual acuity of 20/30 or better in both e yes and complete resolution of subretinal fluid. Conclusions: Patients with paraproteinemia may develop multiple serous detachments of the r etinal pigment epithelium and of the neurosensory retina. The choriore tinopathy in these patients may have been related to their paraprotein emia, type A personality, corticosteroid use, or a combination of thes e factors. The final visual acuity in these three patients was good.