Rheumatoid hyperviscosity syndrome: reversibility of microvascular abnormalities after treatment

Abstract PURPOSE: To report a case of rheumatoid hyperviscosity syndrome involving both retinal and choroidal circulation that resolved after treatment. DESIGN: Interventional case report. METHODS: A 58-year-old woman with clinical and serologic evidence of an inflammatory connective tissue disease without any visual complaints was referred for a funduscopic evaluation. RESULTS: Funduscopic examination revealed marked dilation and beading of the venous system, microaneurysms, and telangiectatic capillary beds in the posterior pole. Fluorescein angiography disclosed delayed choroidal filling, prolonged arteriovenous transit time, and areas of capillary nonperfusion. These findings were accompanied by a severe polyclonal hypergammaglobulinemia and a 10-fold increase in serum viscosity. The ocular findings were reversible after plasmapheresis and steroid treatment. CONCLUSION: Rheumatoid hyperviscosity syndrome can involve both retinal and choroidal circulation. The prominent microvasculopathy is reversible after appropriate treatment.