Abstract
Two patients with Waldenström's macroglobulinemia presented with visual impairment in both eyes. The funduscopic examination showed venous engorgement, retinal hemorrhages, microaneurysms, macular and disc edema. Video fluorescein angiography showed marked disturbances of retinal microcirculation. Due to high intravascular concentration of IgM, plasma viscosity was dramatically increased to values higher than 5 mPas. After plasma exchange procedures plasma viscosity dropped to about 2.5 mPas resulting in improvement of retinal microcirculation. Subsequently the funduscopic appearance of the retina improved. When the maculae flattened in the eyes, visual recovery occurred. These cases demonstrate the significance of blood fluidity and especially plasma viscosity on retinal microcirculation in patients with Waldenström's macroglobulinemia. The improved funduscopic appearance of the retina after the reduction of plasma viscosity proves the pathophysiological correlation between blood fluidity, retinal circulation, and visual function.
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