Posters

Severe superficial calcific corneal deposits following pseudophakic keratopathy in a patient with multiple myeloma

Poster Details

First Author: D.Dibina RUSSIA

Co Author(s):    N. Anisimova   N. Shilova   B. Malyugin              

Abstract Details

Purpose:

To report a case of superficial corneal deposits, to assess the clinical and functional results of surgical treatment and to perform laboratory analysis of the diseased cornea.

Setting:

S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia

Methods:

A 77-year-old man presented with visual impairment in the right eye (RE). Bilateral phacoemulsification with IOL implantation was performed one year ago. Postoperatively the RE had corneal edema. An intensive therapeutic treatment was performed, with no improvement. The patient’s medical history included multiple myeloma that was therapeutically stable compensated. At the primary presentation to our clinic the edematous cornea was revealed at the RE with deposition of whitish corneal opacities in the central zone 3x2mm in size. RE best corrected visual acuity(BCVA)was20/400, central corneal thickness (ССT) was 834µm. Microelemental mapping of the tears and serum samples were performed.

Results:

Serum analysis identified normal levels of calcium, phosphorus and thyroid stimulating hormone. The level of calcium in the tear was high(5.29mg/100ml). The patient underwent scarification of the epithelium with the superficial deposits, and consequent penetrating keratoplasty. The sample from the corneal scarification was investigated by scanning electron microscopy(SEM)and spectrometry. The recipient cornea was investigated by histological examination. Postoperatively RE BCVA was 20/200, CCT was 517µm, and ECD was 2211cells/mm2. Histological examination identified superficial calcification deposits. SEM revealed a bumpy surface with a multilayered symmetrical pattern. Elemental analysis of a corneal scraping was mainly composed of calcium, phosphorus and oxygen.

Conclusions:

Summarizing our data the diagnosis of calcific band keratopathy was confirmed. Сalcific band keratopathy may be mainly triggered by disturbance in the phosphate-buffer system and high Ca concentration due to intensive therapeutic treatment and the PBK itself and/or postchemical therapy of the multiple myeloma. These multiple factors could provide a favorable environment for the extensive formation of the calcific lession that aggravated the course of the pseudophakic keratopathy and led to endothelial decompensation. Penetrating keratoplasty was an effective treatment of corneal decompensation in such complicated case and provided restoration of corneal transparency.

Financial Disclosure:

None