Corneal crystalline deposits as the initial manifestation of IgA-kappa multiple myeloma

Hsueh, Chien-Yu; Lin, Pei Yu; Lee, S. M.; Hsu, Wen-Ming

doi:10.1038/sj.eye.6700716

Cited by 4 publications

(6 citation statements)

References 6 publications

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“…With regard to the stromal crystalline-like PPK reported in the literature, the serological findings included in most cases IgG κ type [ 1 , 3 , 13 , 23 , 25 , 29 – 42 ], in one case IgA κ type [ 43 ] and in two cases IgG λ type [ 13 , 38 ]. In the present study, the patient with the stromal punctiform crystalline-like PPK had an SMM of type IgG κ.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of corneal findings and their interrelation with hematological findings in monoclonal gammopathy

Hariri

Munder²,

Lisch³

et al. 2022

PLoS ONE

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Purpose To determine prevalence of paraproteinemic keratopathy (PPK) among patients with monoclonal gammopathy (MG). To evaluate interrelation between corneal and hematological parameters in patients with PPK. Methods Fifty-one patients with monoclonal gammopathy of undetermined significance (n = 19), smoldering multiple myeloma (n = 5) or multiple myeloma (n = 27) were prospectively included in this study. Best-corrected visual acuity, slit-lamp biomicroscopy, Scheimpflug tomography, in-vivo confocal laser scanning microscopy, optical coherence tomography and complete hematological workup were assessed. Results We identified n = 19 patients with bilateral corneal opacities compatible with PPK. PPK was newly diagnosed in 13 (29%) of 45 patients with a primary hematological diagnosis and in n = 6 patients without previous hematological diagnosis. The most common form was a discreet stromal flake-like PPK (n = 14 of 19). The median level of M-protein (p = 0.59), IgA (p = 0.53), IgG (p = 0.79) and IgM (p = 0.59) did not differ significantly between the patients with and without PPK. The median level of the FLC κ in serum of patients with kappa-restricted plasma cell dyscrasia was 209 mg/l in patients with PPK compared to 38.1 mg/l in patients without PPK (p = 0.18). Median level of FLC lambda in serum of patients with lambda-restricted plasma cell dyscrasia was lower in patients with PPK compared to patients without PPK (p = 0.02). Conclusion The PPK was mostly discreet, but its prevalence (29%) was higher than expected. Median level of the monoclonal paraprotein was not significantly higher in patients with PPK compared to patients without PPK. Our results suggest a lack of correlation between morphology and severity of the ocular findings and severity of the monoclonal gammopathy. Trial registration German Clinical Trial Register: DRKS00023893.

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Section: Discussionmentioning

confidence: 99%

Prevalence of corneal findings and their interrelation with hematological findings in monoclonal gammopathy

Hariri

Munder²,

Lisch³

et al. 2022

PLoS ONE

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“…Although many patients have minimal visual impairment and do not require intervention, those with significant visual symptoms have been treated with several modalities, including superficial keratectomy, 8 penetrating keratoplasty, 9 and systemic therapy. 4,5,[8][9][10][11][12][13] Table 1 presents a summary of cases reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] These deposits have been shown to be immunoglobulins, usually IgG, although rare cases of other immunoglobulins have been reported. 4,5 There are limited reports in the literature regarding the treatment and prognosis of patients with subepithelial corneal crystals. We report the diagnosis and treatment of a patient whose presenting manifestation of symptomatic MM was blurry vision with corneal involvement secondary to paraprotein-associated subepithelial corneal crystalline deposits.…”

Section: Introductionmentioning

confidence: 99%

Subepithelial Corneal Immunoglobulin Deposition as a Manifestation of Multiple Myeloma: A Case Report and Literature Review

Wang

Safran

Richter

et al. 2014

Clinical Lymphoma Myeloma and Leukemia

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“…The pathophysiology of crystal deposition is still largely unclear, but is thought to be related to increased IgG levels (less commonly, IgA) in the tears, aqueous, and limbal vessels of the eye. This then manifests as crystalline deposits usually in the corneal epithelium or stroma, possibly due to spontaneous crystallization of the protein [2,7,8,9].…”

Section: Discussionmentioning

confidence: 99%

“…Symptoms may include photophobia, glare, decreased visual acuity, and irritation, all primarily caused by immunoglobulin deposition (crystal) in the corneal epithelium or stroma [7,8].…”

mentioning

confidence: 99%

Ocular crystal deposition leading to a diagnosis of multiple myeloma: a report of 2 cases and review of the literature

Bharath

Hsia²,

Minuk³

et al. 2014

Open J Hematol

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Corneal crystalline deposits as the initial manifestation of IgA-kappa multiple myeloma

Cited by 4 publications

References 6 publications

Prevalence of corneal findings and their interrelation with hematological findings in monoclonal gammopathy

Prevalence of corneal findings and their interrelation with hematological findings in monoclonal gammopathy

Subepithelial Corneal Immunoglobulin Deposition as a Manifestation of Multiple Myeloma: A Case Report and Literature Review

Ocular crystal deposition leading to a diagnosis of multiple myeloma: a report of 2 cases and review of the literature

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