Bilateral Corneal Copper Deposition in Monoclonal Gammopathy of Undetermined Significance: Diagnostic Insights and Treatment With Descemet Membrane Endothelial Keratoplasty and Descemet Stripping Only.

Abstract

Purpose: To present a case of bilateral corneal copper deposition as the initial sign of monoclonal gammopathy of undetermined significance (MGUS), detailing diagnostic insights and outcomes of treatment with Descemet Membrane Endothelial Keratoplasty (DMEK) and Descemet Stripping Only (DSO).

Methods: Comprehensive ophthalmological evaluation and laboratory testing (including serum copper, protein electrophoresis, immunofixation) were performed. Surgical interventions were DMEK (right eye) and subsequently DSO (left eye), with postoperative monitoring. Anatomic pathology of the surgical specimen was also analyzed.

Results: Ophthalmological evaluation revealed bilateral central corneal deposits at Descemet\x{2019}s membrane. Elevated serum copper and high levels of gamma globulin with absence of malignancy in bone marrow biopsy confirmed MGUS by the hematologist. As to ocular treatment,DMEK initially improved visual acuity but deposits recurred within a year, decreasing vision by 18 months. DSO achieved corneal clearing and improved vision at 3 months, showing promising early results.

Conclusions: Bilateral corneal copper deposition can be a presenting sign of MGUS, mandating systemic investigation. While DMEK offered temporary improvement although recurrence occurred. DSO shows potential as a therapeutic alternative. Recognizing these ocular findings is critical for timely MGUS diagnosis and monitoring, though optimal corneal treatment requires further research.