Decrease in Bilateral Corneal Deposits After Bortezomib/ Dexamethasone Chemotherapy in Monoclonal Gammopathy: Case Report

• A. Klingenstein

  Ludwig-Maximilians University, Department of Ophthalmology, Klinikum der Universität München, Campus Innenstadt, Mathildenstr. 8, D-80336 Munich, Germany

• W.J. Mayer

  Ludwig-Maximilians University, Department of Ophthalmology, Klinikum der Universität München, Campus Innenstadt, Mathildenstr. 8, D-80336 Munich, Germany

• A. Kampik

  Ludwig-Maximilians University, Department of Ophthalmology, Klinikum der Universität München, Campus Innenstadt, Mathildenstr. 8, D-80336 Munich, Germany

Purpose: To evaluate changes of bilateral crystalline corneal deposits via biomicroscopic photography and in vivo confocal microscopy (IVCM) after systemic chemotherapy in a patient with monoclonal gammopathy.

Methods: Ophthalmological examination, slit-lamp biomicroscopic photography and IVCM of each corneal quadrant were performed before and after 4 cycles of combined bortezomib and dexamethasone chemotherapy.

Results: IVCM revealed mainly subepithelial crystalline deposits not affecting keratocytes or antigen presenting cells. After therapy, corneal opacity in slit-lamp biomicroscopic photography and crystalline deposits decreased visibly. Visual acuity remained stable. Subjective symptoms (haziness, photophobia) improved.

Conclusions: This patient suffered from initially unknown monoclonal gammopathy manifesting in bilateral corneal deposits. Crystalline corneal deposits may be associated with systemic disorders such as monoclonal gammopathy. Correct diagnosis is crucial as systemic treatment may improve not only ophthalmological symptoms. Penetrating keratoplasty alone may lead to relapse.

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