A 70-year-old man presented with a 4-month history of progressive blurring, halos, and glare in his right eye. He had been monitored by a hematologist for 7 years for asymptomatic, smoldering multiple myeloma (IgGκ subtype). Slitlamp examination demonstrated bilateral extensive, fine, needlelike corneal epithelial and subepithelial crystals in a whorling pattern (Figure, A). Visual acuity was reduced to 20/60 OD owing to involvement of the visual axis; the visual axis was spared with visual acuity of 20/30 OS. A diagnostic and therapeutic superficial keratectomy was performed on the right eye, with rapid improvement in visual acuity to 20/25 OD after reepithelialization. Results of histologic analysis, including transmission electron microscopy, were consistent with paraproteinemic keratopathy (Figure, B). These findings led to a revised hematologic diagnosis of active multiple myeloma, and treatment with bortezomib, thalidomide, and dexamethasone was initiated. No recurrence of the crystals was observed, and the patient remained asymptomatic with visual acuity of 20/25 OD and 20/30 OS.
Turnbull AMJ, Karmiris E, Anderson DF. Active IgGκ Multiple Myeloma Presenting With Crystalline Keratopathy. JAMA Ophthalmol. 2018;136(7):e181505. doi:10.1001/jamaophthalmol.2018.1505
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