Abstract
Purpose To examine the ocular signs of monoclonal gammopathy and to evaluate ocular comorbidities in subjects with monoclonal gammopathy. Patients and Methods. We analyzed patients from two large referral hematology centers in Budapest, diagnosed and/or treated with monoclonal gammopathy between 1997 and 2020. As a control group, randomly selected individuals of the same age group, without hematological disease, have been included. There were 160 eyes of 80 patients (38.75% males; age 67.61 ± 10.48 (range: 38–85) years) with monoclonal gammopathy and 86 eyes of 43 control subjects (32.56% males; age 62.44 ± 11.89 (range 37–86) years). The hematological diagnosis was MGUS in 9 (11.25%), multiple myeloma in 61 (76.25%), smoldering myeloma in 6 (7.50%), and amyloidosis or Waldenström macroglobulinemia in 2 cases (2.50%–2.50%). Before detailed ophthalmic examination with fundoscopy, 42 subjects with gammopathy (52.50%) and all controls filled the Ocular Surface Disease Index (OSDI) questionnaire. Results The OSDI score and best-corrected visual acuity (BCVA) were significantly worse in subjects with monoclonal gammopathy than in controls (p=0.02; p=0.0005). Among gammopathy subjects, we observed potential corneal immunoglobulin deposition in 6 eyes of 4 (3.75%) patients. Ocular surface disease (p=0.0001), posterior cortical cataract (p=0.01), and cataract (p=0.0001) were significantly more common among gammopathy subjects than in controls (χ2 test). Conclusions Ocular surface disease and cataract are more common, and BCVA is worse in patients with monoclonal gammopathy than in age-matched controls. Therefore, and due to the potential ocular signs and comorbidities of monoclonal gammopathy, we suggest a regular, yearly ophthalmic checkup of these patients to improve their quality of life.
Highlights
Kitti Kormanyos,1,2 Klaudia Kovacs,1 Orsolya Nemeth,3 Gabor Toth,1 Gabor Laszlo Sandor,1 Anita Csorba,1 Cecılia Nora Czako,1 Achim Langenbucher,4 Zoltan Zsolt Nagy,1 Gergely Varga,5 Laszlo Gopcsa,6 Gabor Mikala,6 and Nora Szentmary 1,7
Ocular surface disease and cataract are more common, and best-corrected visual acuity (BCVA) is worse in patients with monoclonal gammopathy than in age-matched controls. erefore, and due to the potential ocular signs and comorbidities of monoclonal gammopathy, we suggest a regular, yearly ophthalmic checkup of these patients to improve their quality of life
Diagnostic criteria for monoclonal gammopathy of undetermined significance (MGUS) according to the 2015 recommendation of the International Myeloma Working Group are bone marrow plasma cell content less than 10%, less than 3 g/dL of monoclonal protein level (M-protein) in the serum, and no indication of organ disruption, that is characteristic for malignant B-cell disease [5,6,7]
Summary
Kitti Kormanyos ,1,2 Klaudia Kovacs, Orsolya Nemeth ,3 Gabor Toth ,1 Gabor Laszlo Sandor, Anita Csorba, Cecılia Nora Czako ,1 Achim Langenbucher ,4 Zoltan Zsolt Nagy ,1 Gergely Varga ,5 Laszlo Gopcsa, Gabor Mikala ,6 and Nora Szentmary 1,7. 1. Introduction e spectrum of monoclonal gammopathies spans clonal plasma cell diseases from monoclonal gammopathy of undetermined significance (MGUS), solitary plasmacytoma, Waldenstrom macroglobulinemia, and asymptomatic or symptomatic multiple myeloma to plasma cell leukemia [1,2,3]. MGUS is considered a premalignant state that has three different types with IgM MGUS, non-IgM MGUS (IgA- and IgG-MGUS), and light chain MGUS. MGUS can cause amyloidosis, a special sort of light chain deposition disease, or non-Hodgkin lymphoma, which are important differential diagnostic entities [4]. Diagnostic criteria for MGUS according to the 2015 recommendation of the International Myeloma Working Group are bone marrow plasma cell content less than 10%, less than 3 g/dL of monoclonal protein level (M-protein) in the serum, and no indication of organ disruption, that is characteristic for malignant B-cell disease (no hypercalcemia, renal failure, anemia, or bone changes) [5,6,7]. Kidneys are involved up to 40% [10], and unexplained polyneuropathy is present in 5–10% [11,12,13]. ere may be insulin autoimmune syndrome [14], infiltrative or restrictive cardiomyopathy [15], gastrointestinal system involvement [16], and infiltrative or “paraneoplastic”-like skin disease [17]
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