What If It’s Not Diabetic Macular Edema?

Multiple myeloma is primarily diagnosed through extraocular findings; however, in patients who have not yet received a diagnosis, hyperviscosity retinopathy and/or paraproteinemic maculopathy may present as initial symptoms. In diabetic patients, the clinical diagnosis can become even more complicated due to diabetic ocular findings. Two diabetic patients presented with retinal hemorrhages and macular edema that did not respond to intravitreal anti-vascular endothelial growth factors. The “silent macula” appearance was observed in both fundus fluorescein angiography (FFA). After systemic investigation, these patients were diagnosed with multiple myeloma. Paraproteinemic maculopathy can particularly mimic diabetic macular edema in diabetic patients and should be considered in cases of atypical findings, particularly when serous retinal detachments are present without apparent leakage on FFA.