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Open Journal of Hematology

ISSN: 2075-907X
Volume 8, 2017

Indexed in:

Open Journal of Hematology, 2014, 5-1 [Case Report]

Ocular crystal deposition leading to a diagnosis of multiple myeloma: a report of 2 cases and review of the literature

Vighnesh Bharath1,  Cyrus C. Hsia2, Leonard Minuk2, Rookaya Mather3, Bruce D. Nichols3

1 PGY-2, Department of Medicine, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Rd. East, London, Ontario, N6A 5W9, Canada
2 Division of Hematology, Department of Medicine, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Rd. East, London, Ontario, N6A 5W9, Canada
3 Department of Ophthalmology, Ivey Eye Institute, St. Joseph’s Health Care, 268 Grosvenor Street, Zone B, Level 1, Room B1-050, London, Ontario, N6A 4V2, Canada

Corresponding Author & Address:

Vighnesh Bharath*
Department of Medicine, London Health Sciences Centre / Western University, 800 Commissioners Rd. East, London, Ontario, N6A 5W9, Canada; Email: vbharath@uwo.ca

Article History:
Published: 4th March, 2014   Accepted: 4th March, 2014
Received: 8th October, 2013      

© Bharath et al.; licensee Ross Science Publishers

ROSS Open Access articles will be distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided that the original work will always be cited properly.

Keywords: multiple myeloma, cornea, crystals, LASIK


Corneal crystal deposition due to multiple myeloma is a rare ocular manifestation caused by elevated immunoglobulin levels in the eye. It presents with decreased visual acuity and crystalline deposits in the corneal epithelium or stroma. We describe here two cases of myeloma crystal deposition in the eye, one of which involved crystal deposition in a Laser-Assisted in situ Keratomileusis (LASIK) interface, and one that demonstrated rapid and complete response of corneal crystals with induction chemotherapy (to our knowledge, the first such cases in the literature). We also present a brief review of the literature. A 50-year-old woman presented with decreased vision and crystal deposition in her LASIK interface. This led to a diagnosis of IgG multiple myeloma and treatment with melphalan and prednisone improved her vision to 20/20, but did not completely resolve the corneal crystals. Similarly, a 53-year-old woman presented with foggy vision and dense ocular crystalline deposits. Work-up revealed smoldering myeloma, and the patient was managed conservatively until she developed end-organ damage including anemia and lytic bone lesions. Systemic therapy was initiated, and the crystal deposits resolved completely. With these cases, we hope that clinicians will recognize these unusual ocular manifestations, and consider myeloma in the differential diagnosis. Further research is warranted, but in light of the observed response to therapy and the significant patient burden associated with vision loss, it may be prudent to consider systemic therapy for myeloma-associated ocular disease (though this is not the current convention), potentially with bortezomib.

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