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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

Neuro-Ophthalmology 12-1.png
Neuro-Ophthalmology 12-2.png
Neuro-Ophthalmology 12-3.png
Neuro-Ophthalmology 12-4.png
Neuro-Ophthalmology 12-5.png

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?

Neuro-Ophthalmology 12-9.png

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?


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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