DR. RADHIKA THUNDIKANDY

DR. VEDHANAYAKI RAJESH

Abstract

A 64 year old male patient presented with defective vision in both eyes .Fundus showed bilateral exudative retinal detachment inferiorly and serous detachment at the macula. He had bone pains in both lower limbs and systemic examination revealed a soft ,non tender fixed swelling at the nape of the neck. Blood investigations revealed anemia ,Hb 8gm% and elevated ESR 120 mm. Urine for Bence Jones proteins was negative but serum electrophoresis revealed M band and bone marrow biopsy showed abnormal plasma cell confirming the diagnosis of multiple myeloma. FFA showed micro aneurysms with no pooling at the macula.” Silent macula” is the hall mark of immunogammopathy. X ray skull showed osteolytic lesions over the swelling suggestive of plasmacytoma. Patient was treated with chemotherapy with compete resolution of the serous detachments. Accumulation of immunoglobulins in the sub retinal space increases the oncotic pressure causing fluid to accumulate in the sub retinal space.