This case of bilateral cystoid macular edema and subfoveal neurosensory retinal detachments is remarkable for both its presentation and response to therapy. The macular edema and macular detachments along with nonspecific complaints of confusion, muscle stiffness, joint pain, and weight loss were the presenting signs and symptoms; signs typically used as guides to initiate treatment for multiple myeloma were not present. Macular edema in the context of paraproteinemia is usually associated with Waldenstrom's macroglobulinemia and has classically been reported as "silent" with respect to fluorescein angiography. Our patient has multiple myeloma and demonstrated leakage on fluorescein angiography. The case is also notable in that there was improvement in visual acuity and restoration of normal macular anatomy after receiving eight cycles of bortezomib and dexamethasone. Bortezomib, a chemotherapeutic agent used to treat refractory or rapidly advancing multiple myeloma, had been used previously to treat similar maculopathy in Waldenstrom disease along with plasmapheresis with resolution of macular edema and improvement in visual acuity. Our patient with multiple myeloma did not require plasmapheresis for significant clinical improvement. Treatment with bortezomib and dexamethasone alone was sufficient to clear the bilateral cystoid macular edema and subretinal fluid.

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