A 58-year-old man, a known diabetic and hypertensive for 5 years was presented to us with a drop in reading vision in both eyes of 2 months duration. His best-corrected visual acuity was 6/24, N36 in both eyes. Fundus findings revealed moderate non-proliferative diabetic retinopathy with bilateral diffuse macular oedema. When conventional therapy with intravitreal ranibizumab did not alter the clinical picture, we looked into the differential diagnosis of bilateral persistent macular detachments and investigated further. Haematological tests revealed severe anaemia with pancytopenia, which prompted further investigations including a bone marrow biopsy confirming a diagnosis of multiple myeloma. Chemotherapy gradually caused resolution of the macular detachments at 8 months follow-up. This report illustrates that a high index of suspicion regarding systemic condition is required in certain cases presenting as diabetic macular oedema, but not responding to the conventional treatment.
Bilateral occurrence of macular hole in X-linked retinoschisis is an extremely rare event. Spectral domain optical coherence tomography (OCT) findings revealed that formation of a macular hole is secondary to the retinoschisis process alone. Bilateral macular holes should be added to the spectrum of X-linked retinoschisis variations and the retinoschisis process alone should be accounted for their formation.
We review 12 consecutive cases of pre-macular fibrosis (PMF) treated by vitreous surgical techniques. The causes of PMF included retinal detachment surgery in four patients, idiopathic in three patients, laser treatment in three patients, pars planitis in one patient and diabetic retinopathy in one patient. The membrane was successfully removed in all the patients. One patient developed a retinal detachment that was repaired successfully. All patients had improved visual acuity (VA) of two Snellen lines or more and six patients achieved VA of 6/12 or better. Patients with PMF following retinal detachment had poorer final VA.
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