A 58-year-old man, a known diabetic and hypertensive for 5 years was presented to us with a drop in reading vision in both eyes of 2 months duration. His best-corrected visual acuity was 6/24, N36 in both eyes. Fundus findings revealed moderate non-proliferative diabetic retinopathy with bilateral diffuse macular oedema. When conventional therapy with intravitreal ranibizumab did not alter the clinical picture, we looked into the differential diagnosis of bilateral persistent macular detachments and investigated further. Haematological tests revealed severe anaemia with pancytopenia, which prompted further investigations including a bone marrow biopsy confirming a diagnosis of multiple myeloma. Chemotherapy gradually caused resolution of the macular detachments at 8 months follow-up. This report illustrates that a high index of suspicion regarding systemic condition is required in certain cases presenting as diabetic macular oedema, but not responding to the conventional treatment.
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