Bilateral Corneal Changes in a Patient With Monoclonal Gammopathy
A 74-year-old man consulted us because of bilateral corneal opacification and mild subjective visual loss. Examination revealed bilateral, multiple, diffuse and also nummular stromal and pre-Descemet opacifications of the cornea (Figure). There was no prior history or family history of eye disease. The patient did, however, have a known monoclonal gammopathy of unclear significance, which was presumably the cause of his clinically evident paraproteinemic keratopathy.
We initially recommended no treatment, because the visual acuity was still 1.0. The potential therapeutic approaches would have included phototherapeutic keratectomy (PTK) and lamellar or perforating keratoplasty.
The clinical manifestations of paraproteinemic keratopathy, in which the observable changes are due to immunoglobulin deposition, are highly varied. The differential diagnosis includes dystrophic, infectious, and inflammatory processes of the cornea, as well as other metabolic diseases with potential corneal involvement. The frequency of keratopathy among patients with paraproteinemia is currently unclear. Plasma-cell disease should be ruled out in any patient with bilateral variable corneal opacifications of uncertain origin. Conversely, the possibility of corneal involvement should be considered in any patient with a known monoclonal gammopathy.
PD Dr. med. Daniel Röck
Prof. Dr. med. Tobias Röck
Prof. Dr. med. Jens Martin Rohrbach
Department für Augenheilkunde, Universitätsklinikum Tübingen, email@example.com
Conflict of interest statement: The authors state that they have no conflict of interest.
Translated from the original German by Ethan Taub, M.D.
Cite this as: Röck D, Röck T, Rohrbach JM: Bilateral corneal changes in a patient with monoclonal gammopathy.
Dtsch Arztebl Int 2020; 117: 270. DOI: 10.3238/arztebl.2020.0270