International Ophthalmology

, Volume 38, Issue 5, pp 2163–2166 | Cite as

Post-transplant erythrocytosis-related maculopathy: successful management of hyperviscosity with phlebotomy

  • Sumeet Khanduja
  • Brijesh TakkarEmail author
  • Neha Khanduja
  • Pradeep Venkatesh
Case Report



To report clinical features in a case of hyperviscosity retinopathy following post-renal transplant erythrocytosis (PTE) and its outcome after phlebotomy.


Fundus fluorescein angiography and optical coherence tomography (OCT) were carried out for a 29-year-old renal allograft recipient who presented with acute unilateral visual loss.


There was mild retinal vascular dilation in both eyes with retinal hemorrhages and retinal opaqueness in left eye. Cystoid macular edema was noted on OCT. Microvascular leaks and micro-occlusions were seen all around the foveal avascular zone on fluorescein angiogram. Investigations revealed hemoglobin to be 16.8 g%, and a PTE was diagnosed. The patient underwent phlebotomy following which there was near complete resolution of macular edema with improvement in vision.


Hyperviscosity retinopathy can cause acute visual loss in cases of renal allograft recipients who develop PTE. Prompt management with phlebotomy can lead to reversal of macular edema in such cases.


Cystoid macular edema Hyperviscosity retinopathy Phlebotomy Post-renal transplant erythrocytosis 


Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest or sources of funding to disclose.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments.


  1. 1.
    Lanzetta P, Monaco P (2004) Major ocular complications after organ transplantation. Indian J Ophthalmol 52:95PubMedPubMedCentralGoogle Scholar
  2. 2.
    Rue KS, Hirsch LK, Sadun AA (2012) Impending anterior ischemic optic neuropathy with elements of retinal vein occlusion in a patient on interferon for polycythemia vera. Clin Ophthalmol 6:1763–1765CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Rezai KA, Patel SC, Eliott D, Becker MA (2002) Rheumatoid hyperviscosity syndrome: reversibility of microvascular abnormalities after treatment. Am J Ophthalmol 134:130–132CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Besirli CG, Johnson MW (2013) Immunogammopathy maculopathy associated with Waldenström macroglobulinemia is refractory to conventional interventions for macular edema. Retin Cases Brief Rep 7:319–324PubMedPubMedCentralGoogle Scholar
  5. 5.
    Vlahakos DV, Marathias KP, Agroyannis B, Madias NE (2003) Post transplant erythrocytosis. Kidney Int 63:1187–1194CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Subijay S, Varun G, Shikha G, Pradeep V, Sumeet K (2012) Bilateral macular infarction secondary to haemodialysis in a patient with chronic renal failure. Clin Exp Ophthalmol 40:e112–e113CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Jayamanne DG, Porter R (1998) Ocular morbidity following renal transplantation. Nephrol Dial Transplant 13:2070–2073CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Jahadi-hosseini HR, Rahmani B, Karbassi A et al (2003) Ocular complications in renal allograft recipients. Transplant Proc 35:309–310CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Oberman AE, Chatterjee SN (1975) Ocular complications in renal transplant recipients. West J Med 123(3):184–187PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • Sumeet Khanduja
    • 1
  • Brijesh Takkar
    • 2
  • Neha Khanduja
    • 3
  • Pradeep Venkatesh
    • 2
  1. 1.Head of DepartmentKalpana Chawla Government Medical College and HospitalKarnalIndia
  2. 2.Retina and Uvea ServicesDr R P Centre for Ophthalmic Sciences, All India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of OphthalmologyIGMCShimlaIndia

Personalised recommendations