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Year : 2020  |  Volume : 68  |  Issue : 8  |  Page : 1663-1664

Multimodal imaging in paraproteinemic keratopathy

1 Department of Ophthalmology, University of California - San Francisco, San Francisco, CA, USA
2 Department of Ophthalmology; Francis I. Proctor Foundation, University of California - San Francisco, San Francisco, CA, USA

Date of Web Publication24-Jul-2020

Correspondence Address:
Dr. Gerami D Seitzman
Department of Ophthalmology, University of California – San Francisco, San Francisco, CA
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_2029_19

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How to cite this article:
Pasricha ND, Lee MD, Seitzman GD. Multimodal imaging in paraproteinemic keratopathy. Indian J Ophthalmol 2020;68:1663-4

How to cite this URL:
Pasricha ND, Lee MD, Seitzman GD. Multimodal imaging in paraproteinemic keratopathy. Indian J Ophthalmol [serial online] 2020 [cited 2020 Aug 12];68:1663-4. Available from: http://www.ijo.in/text.asp?2020/68/8/1663/290410

A 56-year-old female presented for follow-up examination for paraproteinemic keratopathy. Seven years prior, she presented with numerous asymptomatic peripheral corneal stromal nummular lesions in both eyes [Figure 1]a, [Figure 1]b, [Figure 1]c. Transforming growth factor, beta-induced (TGFBI) corneal dystrophy genetic tests were negative. She was referred to the Hematology/Oncology service and diagnosed with chronic lymphocytic leukemia (CLL).[1] Despite no obvious crystalline component on clinical examination, using in vivo confocal microscopy we were able to illustrate a crystalline structure to these corneal lesions [Figure 1]d.[2] The patient has remained asymptomatic with best-corrected Snellen visual acuity of 20/20 in each eye.[3] In summary, paraproteinemic keratopathy may be the presenting sign of any systemic disease with paraproteinemia and confocal microscopy may be helpful in the characterization of paraproteinemic keratopathy.[1],[4],[5]
Figure 1: (a) Retroillumination slit lamp photo of peripheral corneal nummular stromal lesions. (b) Cross-sectional slit lamp photo highlighting the predominantly anterior stromal location. (c) Anterior segment OCT demonstrating both anterior (top) and posterior (bottom) stromal lesions. (d) In vivo confocal microscopy demonstrating a crystalline morphology of the corneal lesions

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

Gerami Seitzman, MD consults for Dompe Pharmaceuticals (not relevant to this article).

  References Top

Mannis TE, Mannis GN, Waterhouse EG, Aldave AJ, Rose-Nussbaumer J. Paraproteinemic keratopathy as the presenting sign of hematologic malignancy. Am J Hematol 2016;91:961-2.  Back to cited text no. 1
Milman T, Kao AA, Chu D, Gorski M, Steiner A, Simon CZ, et al. Paraproteinemic keratopathy: The expanding diversity of clinical and pathologic manifestations. Ophthalmology 2015;122:1748-56.  Back to cited text no. 2
Tainsh LT, Coady PA, Sinard JH, Neparidze N, Meskin SW, Adelman RA, et al. Asymmetric deep stromal keratopathy in a patient with multiple myeloma. Cornea 2017;36:372-4.  Back to cited text no. 3
Wasielica-Poslednik J, Gericke A, Munder M, Pfeiffer N, Lisch W. Hematological diagnosis in the corneal consultation. Ophthalmologe 2018;115:765-8.  Back to cited text no. 4
Ormerod LD, Collin HB, Dohlman CH, Craft JL, Desforges JF, Albert DM. Paraproteinemic crystalline keratopathy. Ophthalmology 1988;95:202-12.  Back to cited text no. 5


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