Bilateral simultaneous central retinal vein occlusion secondary to hyperviscosity in Waldenstrom's macroglobulinaemia

Purpose Central retinal vein occlusions (CRVOs) are rarely treatable; most therapy is directed towards prevention or treatment of complications. Bilateral CRVO can be due to serum hyperviscosity, which affects 15% of all patients with Waldenstrom's macroglobulinaemia (WM). Although previously reported in a handful of cases, bilateral CRVO is a rare presenting feature. Patients and methods Illustrated case reports of three patients presenting with bilateral CRVO due to undiagnosed WM. Results Plasma exchange, which successfully restored vision in two patients, was followed by long-term cytotoxic therapy. Conclusions Plasma electrophoresis should be performed in all patients with retinal vein occlusions to exclude a paraproteinaemia. In patients with bilateral venous changes, there should be a very high level of suspicion of hyperviscosity, with the possibility of effective early therapy.