Case Series
A series of 4 cases of distinct keratopathy secondary to dysproteinemia: Immunotactoid keratopathy

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Abstract

Objective

To describe a series of 4 cases of immunotactoid keratopathy (ITK) secondary to monoclonal gammopathy.

Design

Multicentre retrospective case series of 4 patients.

Participants

Eight eyes of 4 patients presenting to a cornea service with ITK.

Methods

Retrospective case series of 4 patients referred between 2011 and 2013 for bilateral corneal opacities. Work-up including serum protein electrophoresis was performed, and slit-lamp photographs were obtained.

Results

After investigation, diagnoses of ITK secondary to monoclonal gammopathy of unknown significance were established in 3 cases. In 1 patient, the diagnosis of monoclonal gammopathy of unknown significance was established prereferral.

Conclusions

ITK secondary to plasma cell disorders can clinically resemble a broad category of disease processes and must be considered when evaluating patients with bilateral peripheral stromal opacities. Our series validates previously proposed classification schemes for these opacities.

Résumé

Objet

Une série de 4 cas de kératopathie distincte secondaire à une dysprotéinémie-kératopathie immunotactoïde.

Nature

Rétrospective multicentrique d’une série de cas de 4 patients.

Participants

8 yeux de 4 patients présentant à un service cornéen avec une kératopathie immunotactoïde.

Objet

Description d’une série de 4 cas de kératopathie immunotactoïde secondaire à une gammopathie monoclonale.

Méthodes

Rétrospective d’une série de cas de 4 patients qui s’étaient présentés entre 2011 et 2013 pour opacité cornéenne bilatérale. On leur a appliqué une électrophorèse de protéines sériques (EPPS) et obtenu des photographies à lampe à fente.

Résultats

Après l’investigation, les diagnostics de kératopathie immunotactoïde secondaire à la MGUS ont été établis dans trois cas. Chez un patient, le diagnostic de MGUS a été établi avant l’orientation.

Conclusion

La kératopathie immunotactoïde, secondaire aux troubles plasmocytiques, peut ressembler cliniquement à une grande catégorie de processus morbides et doit être considérée lors de l’évaluation de patients avec opacités bilatérales du stroma périphérique. Notre série valide les schèmes de classification de ces opacités proposée précédemment.

Section snippets

Case 1

A 66-year-old white male was referred to the cornea service with a history of increased photosensitivity in both eyes over several months, preceded by an episode of redness that self-resolved. He denied fevers, night sweats, weight loss, or fatigue. Medical history was significant for Ménière’s disease, gout, depression, and treated squamous cell carcinoma.

On examination, visual acuity was 6/6 OU. Slit-lamp examination revealed mild nuclear sclerotic cataract in both eyes, and a deep and quiet

Discussion

Meesman first reported the association of bilateral crystalline deposition in the cornea and hypergammaglobulinemia in 1934.2 Since then, numerous descriptions of the association with MGUS have been made.1, 2, 3, 4, 5, 6, 7, 8, 9 The term immunotactoid keratopathy (ITK) was coined by Garibaldi et al.2 to describe the corneal deposition of IgG κ as tubular, electron-dense, crystalloid deposits with a central lucent core on electron microscopy. This aligns the ophthalmic literature with the

Conclusions

The association of ITK with lymphoplasmacytic disorders, particularly MGUS, is well established. Ophthalmologists should familiarize themselves with the Lisch classification to enable the detection of corneal immunoglobulin in its various forms. The observation of an unusual bilateral corneal opacification or corneal protein deposition should prompt the ophthalmologist to raise consideration of this potential malignant association and the need for investigations to detect a monoclonal protein

Disclosure

The authors have no proprietary or commercial interest in any materials discussed in this article.

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