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(Investigative Ophthalmology and Visual Science. 2008;49:1157-1160.)
© 2008 by The Association for Research in Vision and Ophthalmology, Inc.
DOI:  10.1167/iovs.07-1254
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Effect of Plasmapheresis on Hyperviscosity-Related Retinopathy and Retinal Hemodynamics in Patients with Waldenström’s Macroglobulinemia

Marcel N. Menke,1,2,3 Gilbert T. Feke,1,2 J. Wallace McMeel,1,4 and Steven P. Treon5,6

1From the Schepens Retina Associates Foundation, Boston, Massachusetts; the 2Division of Ophthalmology, Department of Surgery, and the 4Departments of Ophthalmology and 5Medicine, Harvard Medical School, Boston, Massachusetts; and the 6Bing Center for Waldenström’s Macroglobulinemia, Dana Farber Cancer Institute, Boston, Massachusetts.

PURPOSE. Waldenström’s macroglobulinemia (WM) is characterized by an overproduction of immunoglobulin M (IgM), which can lead to a hyperviscosity syndrome (HVS) and HVS-related retinopathy. Plasmapheresis is known to reduce serum viscosity (SV) and IgM levels. The purpose of this study was to investigate the effects of plasmapheresis on HVS-related retinopathy and retinal hemodynamic parameters in patients with WM.

METHODS. Nine patients with HVS due to WM were studied. SV and plasma IgM levels were measured before and after plasmapheresis treatment. The patients were evaluated for HVS-related retinopathy, and hemodynamic changes in a major temporal retinal vein by laser Doppler, before and after plasmapheresis.

RESULTS. Plasmapheresis resulted in significant reductions in serum IgM (46.5% ± 18.0%, mean ± SD; P = 0.0009) and SV (44.7% ± 17.3%, P = 0.002). HVS-related retinopathy improved in all patients after plasmapheresis. After treatment, the venous diameter decreased in each patient by an average of 15.3% ± 5.8% (P = 0.0001). A significant (P = 0.0004) 55.2% ± 22.5% increase in retinal venous blood speed accompanied the decreases in diameter. There was no significant change in the retinal blood flow rate after treatment. The percentage decreases in SV in the patients were significantly correlated with the percentage decreases in venous blood column diameter (P = 0.031, R2 = 0.51).

CONCLUSIONS. HVS triggers a distinctive retinopathy with a central retinal vein occlusion (CRVO)-like appearance. However, the retinal blood flow is not decreased as in CRVO, but remains at normal levels. Plasmapheresis is effective in reversing HVS-related retinopathy and in reducing abnormal venous dilatation.






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