Paraneoplastic maculopathy mimicking diabetic macular edema

Objective: To highlight paraproteinemic maculopathy as a potential initial manifestation of multiple myeloma and to emphasize its ability to mimic diabetic macular edema in patients with diabetes. Methods: Two diabetic patients presenting with macular edema unresponsive to intravitreal anti-vascular endothelial growth factor therapy were evaluated. Detailed ophthalmic examination and fundus fluorescein angiography (FFA) were performed, followed by systemic investigations. Results: Subsequent systemic evaluation led to the diagnosis of multiple myeloma in both patients and with systemic therapy, a marked regression of findings was observed in all eyes. Conclusions: Paraproteinemic maculopathy may present as an initial ocular manifestation of multiple myeloma and can closely mimic diabetic macular edema. It should be considered in diabetic patients with atypical macular findings, particularly therapy nonresponsive serous macular detachment.