Multimodal imaging in paraproteinemic keratopathy.

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 [Fig. 1a-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 [Fig. 1d].[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.[145]

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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Conflicts of interest

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