Recurrence of paraproteinemic keratopathy after penetrating keratoplasty and its assessment with confocal microscopy
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...
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| Format: | Article |
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Elsevier
2018-09-01
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| Series: | American Journal of Ophthalmology Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993618300902 |
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| author | J. Wasielica-Poslednik A. Gericke A. Desuki U. Schlötzer-Schrehardt N. Pfeiffer W. Lisch |
| author_facet | J. Wasielica-Poslednik A. Gericke A. Desuki U. Schlötzer-Schrehardt N. Pfeiffer W. Lisch |
| author_sort | J. Wasielica-Poslednik |
| collection | DOAJ |
| description | 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 |
| first_indexed | 2024-12-21T12:27:31Z |
| format | Article |
| id | doaj.art-a6b9b6722b26439d89e3da62955ddd82 |
| institution | Directory Open Access Journal |
| issn | 2451-9936 |
| language | English |
| last_indexed | 2024-12-21T12:27:31Z |
| publishDate | 2018-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj.art-a6b9b6722b26439d89e3da62955ddd822022-12-21T19:04:08ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362018-09-01118791Recurrence of paraproteinemic keratopathy after penetrating keratoplasty and its assessment with confocal microscopyJ. Wasielica-Poslednik0A. Gericke1A. Desuki2U. Schlötzer-Schrehardt3N. Pfeiffer4W. Lisch5Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Corresponding author. University Medical Center of the Johannes Gutenberg- University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, GermanyDepartment of Internal Medicine III, University Medical Center of the Johannes Gutenberg-University Mainz, GermanyDepartment of Ophthalmology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, GermanyDepartment of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, GermanyDepartment of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, GermanyPurpose: 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 opacityhttp://www.sciencedirect.com/science/article/pii/S2451993618300902 |
| spellingShingle | J. Wasielica-Poslednik A. Gericke A. Desuki U. Schlötzer-Schrehardt N. Pfeiffer W. Lisch Recurrence of paraproteinemic keratopathy after penetrating keratoplasty and its assessment with confocal microscopy American Journal of Ophthalmology Case Reports |
| title | Recurrence of paraproteinemic keratopathy after penetrating keratoplasty and its assessment with confocal microscopy |
| title_full | Recurrence of paraproteinemic keratopathy after penetrating keratoplasty and its assessment with confocal microscopy |
| title_fullStr | Recurrence of paraproteinemic keratopathy after penetrating keratoplasty and its assessment with confocal microscopy |
| title_full_unstemmed | Recurrence of paraproteinemic keratopathy after penetrating keratoplasty and its assessment with confocal microscopy |
| title_short | Recurrence of paraproteinemic keratopathy after penetrating keratoplasty and its assessment with confocal microscopy |
| title_sort | recurrence of paraproteinemic keratopathy after penetrating keratoplasty and its assessment with confocal microscopy |
| url | http://www.sciencedirect.com/science/article/pii/S2451993618300902 |
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