Circulatory disturbances due to HV can be best appreciated by ophthalmoscopy. Approximately 10% of
^ Venous "sausaging"
Optic disc edema , i Dilated veins kclina) hemorrhaRcs
Figure 88.1 Ocular exam of a patient with Waldenstrom's macroglobulinemia depicting typical findings of hyperviscosity
Among the first clinical signs of HV is the appearance of peripheral and mid-peripheral dot- and blot-like hemorrhages in the retina, which are best appreciated with indirect ophthalmoscopy and scleral depression.3031 In more severe cases of HVS, dot, blot, and flame-shaped hemorrhages can appear in the macular area, and may be accompanied by retinal edema and visual disturbance. Although visual acuity usually improves with plasmapheresis treatment, irreversible visual loss has been reported.32 Some patients with HVS show papilledema and markedly dilated and tortuous veins with focal constrictions, predominantly at the arterio-venous junctions (i.e., venous sausaging). Other clinical findings associated with HVS can include intraretinal exudates resulting from more severe leakage from retinal vessels and retinal detachments.33 Fluorescein angiography may be helpful in cases of intraretinal exudates in identifying areas of leakage.
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