Purpose: To describe a rare case of cystoid macular edema (CME) associated with immunoglobulin A κ smoldering multiple myeloma and highlight the importance of considering myeloma spectrum disorders in unexplained CME. Methods: A single clinical case was reviewed. Results: A 67-year-old man presented with a 2-week history of episodic blurry vision in his left eye. Physical examination and multimodal imaging revealed CME in the left eye and minimal ellipsoid zone abnormalities in the right eye. The CME persisted despite treatment with topical nonsteroidal anti-inflammatory drugs and corticosteroids but slowly improved with topical dorzolamide. No systemic treatment for smoldering multiple myeloma was initiated during the observation period. Conclusions: This case represents a rare ocular manifestation of smoldering multiple myeloma and underscores the importance of considering myeloma spectrum disorders in cases of unexplained or treatment-resistant CME.
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