Ophthalmologic Techniques to Assess the Severity of Hyperviscosity Syndrome and the Effect of Plasmapheresis in Patients with Waldenström's Macroglobulinemia

BackgroundThe aim of this study is to determine the serum immunoglobulin (Ig) M and serum viscosity (SV) levels at which retinal changes associated with hyperviscosity syndrome (HVS) as a result of Waldenström's macroglobulinemia (WM) occur. In addition, the effect of plasmapheresis on HVS-related retinopathy was tested.Patients and MethodsA total of 46 patients with WM received indirect ophthalmoscopy, laser Doppler retinal blood flow measurements, serum IgM, and SV determinations. A total of 9 patients with HVS were studied before and after plasmapheresis.ResultsMean IgM and SV levels of patients with the earliest retinal changes were 5442 mg/dL and 3.1 cp, respectively. Plasmapheresis improved retinopathy, decreased serum IgM (46.5 ± 18%; P = .0009), SV (44.7 ± 17.3%; P = .002), retinal venous diameter (15.3 ± 5.8%; P = .0001), and increased venous blood speed by +55.2 ± 22.5% (P = .0004).ConclusionExamination of the retina is useful in identifying the symptomatic threshold of plasma viscosity levels in patients with HVS and can be used to gauge the effectiveness of plasmapheresis treatment.