Recurrence of paraproteinemic keratopathy after penetrating keratoplasty and its assessment with confocal microscopy

Autor: J. Wasielica-Poslednik, A. Gericke, A. Desuki, U. Schlötzer-Schrehardt, N. Pfeiffer, W. Lisch
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Zdroj: American Journal of Ophthalmology Case Reports, Vol 11, Iss , Pp 87-91 (2018)
Druh dokumentu: article
ISSN: 2451-9936
DOI: 10.1016/j.ajoc.2018.06.014
Popis: Purpose: To report on a case of recurrence of paraproteinemic keratopathy (PPK) associated with monoclonal gammopathy after bilateral penetrating keratoplasty. Observations: Penetrating keratoplasty was performed on both eyes of a 45-year-old man due to bilateral progressive corneal stromal clouding. Recurrence of the corneal stromal opacities accompanied by a decrease in visual acuity was observed on slit-lamp examination already two years after penetrating keratoplasty. Confocal laser scanning microscopy (CLSM) of the corneal grafts performed three years after penetrating keratoplasty showed bilateral morphological changes identical to that found in the patient's corneas prior to penetrating keratoplasty. A hematological work-up revealed monoclonal gammopathy of type IgG kappa. The histochemical examination of the explanted corneas confirmed the diagnosis of PPK. Conclusions and importance: Paraproteinemic keratopathy is an underdiagnosed ophthalmological condition, which may be associated with potentially life-threatening hematologic disorders. A hematological workup should be performed in patients with corneal opacities of uncertain etiology. Penetrating keratoplasty should be performed with caution in patients with monoclonal gammopathy due to the possibility of a very fast recurrence of PPK in the corneal graft. This is the first presentation of the recurrence of flake-like PPK after penetrating keratoplasty assessed with CLSM. Keywords: Paraproteinemic keratopathy, Monoclonal gammopathy of undetermined significance, Confocal microscopy, Corneal opacity
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