Occult retinal pigment epithelial detachment in hyperviscosity syndrome

We document and evaluate a serous retinal detachment in a patient with hype rviscocity syndrome. Optical coherence tomographic images of the serous ret inal detachment in a patient with hyperviscocity syndrome were correlated w ith slit-lamp biomicroscopic findings, fundus photographs, fluorescein angi ograms, and indocyanine green angiograms. Fluorescein angiography demonstra ted venous and capillary bed abnormalities but no leakage or pooling of flu orescein corresponding to the retinal pigment epithelial detachment (PED) b eneath the serous retinal detachment. Indocyanine green angiogram disclosed a delay of intrachoroidal circulation. Optical coherence tomography (OCT) revealed a large retinal pigment epithelial detachment beneath the serous r etinal detachment. The occult retinal FED beneath the neurosensory retinal detachment was detected only by OCT in a patient with hyperviscosity syndro me. We suggest that gamma globulin, which is the hyperviscosity material, a ccumulated in the subretinal pigment epithelial space and blocked the leaka ge or pooling of fluorescein corresponding to the retinal pigment epithelia l detachment.