Intravitreal bevacizumab: a viable treatment for bilateral central retinal vein occlusion with serous macular detachment secondary to Waldenström macroglobulinaemia.

Waldenstr€ om macroglobulinaemia (WM), also known as Waldenstr€ om lymphoma, is one of the malignant monoclonal gammopathies. The World Health Organization defines WM as a lymphoplasmacytic lymphoma associated with a monoclonal immunoglobulin M (IgM) protein (Buske et al, 2013). It is characterized by the presence of high levels of IgM, elevated serum viscosity and the presence of lymphoplasmacytic infiltrate in the bone marrow. Due to the elevated serum viscosity, central retinal vein occlusion (CRVO) in the eye is a known, albeit rare, complication. Conventional treatment options for CRVO include treatment of the underlying predisposing factors, retinal photocoagulation, intravitreal steroids and, most recently, intravitreal anti-vascular endothelial growth factors (VEGF) and steroid implants. However, cases of CRVO in patients with WM are usually refractive to treatment (Caimi et al, 2013). We report a rare case of WM presenting as CRVO with serous macular detachment, which was responsive to intravitreal bevacizumab. A 65-year-old gentleman presented to an ophthalmologist with right eye (OD) blurring of vision (1/60) and was diagnosed with CRVO with macular oedema. He had history of hypertension but this was under control. A week later his left eye (OS) became blurred with vision 6/60, which was also noted to be CRVO. Fundus examination showed extensive retinal haemorrhages and macular oedema bilaterally. Optical coherence tomography (OCT) was undertaken, which