Diagnostic and therapeutic challenges

摘要

A 55-year-old Chinese woman was referred by the hematologists to the Eye Institute, University of Hong Kong, for further assessment due to her reduced vision and metamorphopsia since July 2011. She was diagnosed to have monoclonal gammopathy of undetermined significance (MGUS) since 2006 by the hematologists, and it has been stable without any intervention.On initial presentation to us in November 2011, she revealed a history of reduced vision in the left eye for a few months, which was gradual and with metamorphopsia. Otherwise, she did not complain of any systemic unwell other than the ocular symptoms. There was no fever or any weight loss. Her initial best-corrected visual acuity was 20/30 in the right eye and 20/200 in the left eye.The observations from examination of the anterior segment and lens were normal bilaterally. Examination of the right fundus showed a few subretinal white dots scattered in the posterior pole, associated ,with surrounding thin layer of subretinal fluid temporal to the disk (Figure 1). Examination of the left fundus showed a larger white grayish subretinal nodule, located superotemporal to the macular, which measured approximately 1 disk diameter in size, associated with surrounding subretinal fluid and retinal wrinkles (Figure 1). The disks looked normal, and retinal vessels appeared unremarkable. Vitreous was also clear bilaterally.