Neuro-Ophthalmology

Case 12

Patient Presentation: A 27-year-old male with a past medical history of multiple myeloma presented with 5 days vision loss OD. His visual acuity was CF @ 1ft OD and 20/20 OS. There is a right RAPD. Humphrey visual fields are shown below

Question: A dilated fundus examination is performed with OCT 5-line raster images with vertically-oriented lines as shown above. What is the main abnormality seen on the OCT?

Fundus auto-fluorescence provided additional confirmation of retinal folds. Linear striations with increased signal intensity are visualized as shown above (red arrows).

Question: What are potential causes of retinal folds?

Question: Given the examination and OCT findings, where is the compressive lesion causing the optic neuropathy?

Question: What is the most common ocular complications associated with multiple myeloma?

References:

1. Franklin RM, Kenyon KR, Green WR, Saral R, Humphrey R. Epibulbar IgA Plasmacytoma Occurring in Multiple Myeloma. Arch Ophthalmol. 1982;100(3):451–456.

2. Fung S, Selva D, Leibovitch I, Hsuan J, Crompton J. Ophthalmic Manifestations of Multiple Myeloma. Ophthalmologica. 2005. 219;43-8.

Learning Objectives:

1. To recognize and diagnose retinal folds on OCT

2. To recognize the ocular manifestations associated with multiple myeloma

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