Monoclonal corneal gammopathy: topographic considerations.
Desposition of immunoglobulins in the cornea occasionally occurs in benign and malignant lymphoproliferative conditions. A 52-year-old woman with recently discovered monoclonal gammopathy of undetermined significance (MGUS) was referred to our hospital. Slit-lamp and ultrasound biomicroscopy revealed bilateral deposits within all corneal layers. The precipitates were organized in a circle, leaving a perilimbal zone and the axial cornea clear. Light microscopy of a biopsy disclosed confluent subepithelial deposits and defects in Bowman's layer. Immunoperoxidase reaction was positive only for IgG and IgG-kappa. Transmission electron microscopy confirmed the presence of extracellular rectangular and arcuate immunoglobulin crystalloids with a 10-nm periodicity but a non-crystalline defraction pattern. A review of the literature showed that the circumferential pattern of immunoglobulin deposition is associated with short-term visual symptoms and good visual acuity. The present report supports a hypothesis of immunoglobulin deposition via the limbal arcade and contradicts the "tear theory."
Department of Ophthalmology, University Eye Hospital, University of Bonn, Germany.
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Sekundo
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Seifert
D001706:Biopsy; D003315:Cornea / Q000648:ultrastructure; D003316:Corneal Diseases / Q000276:immunology / Q000473:pathology*; D004848:Epithelium / Q000648:ultrastructure; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D007150:Immunohistochemistry; D008854:Microscopy, Electron; D008875:Middle Aged; D010265:Paraproteinemias / Q000276:immunology / Q000473:pathology*
D007074:Immunoglobulin G