PMC4010642_01
Clinical photographs of the right cornea.. Notes: (A) Subepithelial deposits extending toward the corneal center by fingerlike projections; (B) at higher magnification, depicting the spiral-like pattern known as corneal verticillata.
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OU. On examination, she had marked grayish intraepithelial corneal opacities in a pattern of hazy spiraling lines in both eyes (Figure 1).
Serum immunofixation electrophoresis and its graphical representation.. Notes: (A) ELP, G, A, M, K, and L. The arrow indicates the position of the monoclonal protein. (B) A large spike in the gamma region is shaded in pink.. Abbreviations: ELP, serum protein electrophoresis; G, immunoglobulin G; A, immunoglobulin A; M, immunoglobulin M; K, kappa light chain; L, lambda light chain.
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Systemic investigation revealed a raised serum IgG with a kappa paraprotein band (12.4 g/L) on serum protein electrophoresis (Figure 2).
Electron microscopy of the corneal biopsy specimen.. Notes: (A) Numerous epithelial rod-shaped bodies (original magnification, x7,200). (B) Epithelial rod-shaped body at higher magnification (original magnification, x19,000). (C) Numerous intracellular hexagonal-shaped bodies (original magnification, x19,000). (D) Intracellular hexagonal-shaped bodies at higher magnification (original magnification, x29,000).
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On transmission electron microscopy, there was evidence of intraepithelial intracellular and extracellular geometrically irregular hexagonal electron dense particles (Figure 3).
Before and after photographs of right cornea.. Notes: (A) Before: cloudy cornea at baseline. (B) After: after receiving treatment for myeloma the corneal cloudiness started improving.
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Six months later, there was significant improvement in corneal clarity (Figure 4).