Corneal snowfl akes

摘要

An otherwise healthy 45-year-old woman presented with a 6-month history of gradual visual loss in both eyes. Her best-corrected visual acuity was 20/30 in both eyes. Slit-lamp examination showed bilateral-predominantly peripheral-corneal deposits of numerous minute, crystalline materials (figure A and B). The remainder of the ocular examination was unremarkable. A clinical diagnosis of monoclonal gammopathy was made on the basis of shimmering and polychromatic corneal deposits. Serum IgG concentration was 30-3 g/L (normal 8-1-16-9 g/L) and serum electrophoresis showed a monoclonal gammopathy involving IgG-kappa light chain. Our patient was referred to a haematologist and IgG-kappa multiple myeloma was diagnosed by bone marrow biopsy. Treatment was initiated with thalidomide, and no ocular-specific drugs were prescribed. During the 7-year follow-up, while maintained on a low-dose thalidomide, our patient was regularly followed up and her vision remained stable. Although still present, the , amount of these corneal crystalline deposits appeared to be decreasing and migrate away from the peripheral corneas (figure C and D).