Corneal Structural Changes in Nonneoplastic and Neoplastic Monoclonal Gammopathies

Abstract

METHODS. Three groups of subjects were considered: group 1, twenty normal subjects; group 2, fifteen patients with monoclonal gammopathy of undetermined significance (MGUS); group 3, eight patients with smoldering multiple myeloma and eight patients with untreated multiple myeloma. After hematologic diagnosis, patients underwent ophthalmologic exam and in vivo confocal microscopic study. The statistical analysis was performed using ANOVA and Student-Newman-Keuls tests and receiver operating characteristic (ROC) curve analysis.RESULTS. Epithelial cells of gammopathic patients showed significantly higher reflectivity than controls, demonstrated by optical density (P < 0.001). Subbasal nerve density, branching, and beading were significantly altered in gammopathic patients (P ¼ 0.01, P ¼ 0.02, P ¼ 0.02, respectively). The number of keratocytes was significantly reduced in neoplastic patients (P < 0.001 versus both normal and MGUS) in the anterior, medium, and posterior stroma. The ROC curve analysis showed good sensitivity and specificity for this parameter. Group 2 and 3 keratocytes showed higher nuclear and cytoplasmatic reflectivity in the medium and posterior stroma. Endothelial cells were not affected. CONCLUSIONS.Patients with neoplastic gammopathies showed peculiar alterations of the keratocyte number, which appeared significantly reduced. A follow-up with corneal confocal microscopy of patients with MGUS is suggested as a useful tool to identify peripheral tissue alterations linked to possible neoplastic disease development.

Non-invasive detection of corneal sub-basal nerve plexus changes in multiple myeloma patients by confocal laser scanning microscopy

“…The absence of neuromas in their results might be due to another selection of image stacks or to differences in the employed CLSM instrument (Nidek vs Heidelberg), which may lead to different resolutions, making neuroma detection more difficult. Most notably, Aragona et al examined exclusively untreated patients, while the herein presented study included patients in different stages of disease with the majority undergoing treatment [23]. Further, neuropathic symptoms were not focused within the analyzed patient cohort of Aragona et al [23].…”

“…Aragona et al previously used in vivo confocal microscopy in patients with MM [23]. Their study group contained 16 newly diagnosed and untreated patients with MM.…”

Monoclonal gammopathy of “ocular” significance

“…7 In the absence of clinically evident corneal opacity, confocal microscopy can be used to reveal structural changes throughout all corneal layers except the endothelium. 8 We hypothesize that endothelial dysfunction secondary to FCD may have contributed to the posterior locus of the deposits in our patient. It is unclear, however, why the central cornea was spared, although thickened Descemet membrane and guttae may have prevented the transition of the proteins into the central cornea.…”

Characterization of corneal deposition keratopathy in the setting of blood cell dyscrasia and a minimally invasive technique to clear the cornea in a single case

“…The depth and distribution of corneal deposits in the setting of paraproteinemia is also variable. 9 The depth of the deposits might be determined by the source, with deposited material entering the eye from the tear film, limbal vessels, or aqueous to reach these locations, respectively. Corneal stroma appears to be the most commonly reported location of such deposits, followed by the epithelium and subepithelium.…”

“…Corneal stroma appears to be the most commonly reported location of such deposits, followed by the epithelium and subepithelium. 1 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 There have been several reported cases of deposition occurring in all layers of the cornea as well as the conjunctiva, and rare reports of deposition in the lens, ciliary processes, pars plana, and choroid. 1 The endothelium and Descemet membrane are relatively uncommon locations for such corneal deposition, reported in only 2 previous reports.…”