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

Abstract

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.