Corneal crystalline deposits in multiple myeloma. A case report.

A 70-year-old man with a seronegative rheumatoid arthritis showed some peculiar lamellar crystalline deposits mainly at the Descement/endothelial level in both eyes. Serum protein analysis revealed a monoclonal gammopathy with increased amounts of IgG and K-light chains along with traces of the latter in the urine. Corneal biopsy was not available, but electron microscopy of the conjunctival specimen demonstrated crystalline deposits within the endoplasmic reticulum of plasma cells lying within the connective tissue. This material is supposed to be of protein nature. It seems reasonable that the conjunctival deposits are identical to those seen in the cornea by slit-lamp examination, and it is also suggested that they represents paraprotein aggregates. After treatment with melphalan (Alkeran) and prednisone systemically, the corneal deposits decreased over a period of 9 months with corresponding improvement of the visual acuity.

Idiopathic haemochromatosis and eye symptoms. A case report.

A 61-year-old man with idiopathic haemochromatosis and eye symptoms is described. The examination showed microaneurysms scattered over the bulbar conjunctiva, and some discrete pigmentations in the superficial tissue in the perilimbal area. Each cornea revealed a light brown, ellipsoid opacity with the longest diameter horizontally, seemingly being located in the corneal epithelium and/or the anterior part of the stroma. A corneal biopsy was examined by light and electron microscopy. Two different types of granules were found mainly located to the Bowman's membrane. X-ray microanalysis showed no detectable amounts of iron, but high concentrations of phosphorus and calcium, and in addition magnesium in one type of the granules. Treatment with EDTA improved the vision considerably.

Outpatient anterior chamber lens implantation.

100 outpatient and 143 inpatient intracapsular cataract extractions with anterior chamber lens implantation were examined 6 months post-operatively. 74 (74%) in the former and 107 (75%) in the latter achieved visual acuity greater than or equal to 0.5. Excluding non-surgical pathology, 93% in the outpatient group and 98% in the inpatient group had a visual acuity greater than or equal to 0.5 (P = 0.12). There were no significant differences in post-operative complications except for the incidence of cystoid macular edema. Six (6%) of the outpatient and 1 (0.7%) of the inpatient procedures had cystoid macular edema that resulted in a visual acuity below 0.5 (P = 0.02).

The middle-Norway eye-screening study. II. Prevalence of simple and capsular glaucoma.

In this population-based screening study, dealing with 1941 persons above 64 years of age from three different municipalities, the overall open-angle glaucoma prevalence was found to be 8.3%. The prevalence in the separate areas (7.0%, 8.6%, and 9.5%) were not statistically different. Roughly 30% of the population with pseudo-exfoliation syndrome had glaucoma, and 4.2% had ocular hypertension, whereas the corresponding figures for those without pseudo-exfoliation were 4% and 0.8%, respectively. The high glaucoma rates are partly due to the high pseudo-exfoliation prevalence in the area. The prevalence of the capsular glaucoma increased towards a maximum between 75 and 79 years of age, whereafter the curve declined. This may indicate reduced survival time of glaucomatous patients.

The middle-Norway eye-screening study. III. The prevalence of capsular glaucoma is influenced by blood-group antigens.

The association between blood groups (ABO, Rh, Kell, Duffy) and pseudo-exfoliation syndrome, simple, and capsular glaucoma have been evaluated. The findings were: 1). No statistically significant abnormalities regarding blood group distribution in persons with pseudo-exfoliation syndrome. 2). In contrast to simple glaucoma, capsular glaucoma showed an abnormal distribution in the ABO- and the Kell-system. There was less glaucoma prevalence in the capsular A1-group compared to the O-group (p = 0.013), and less in the K1 negative group compared to the K1 positive one (p = 0.005). This trend was even escalated when combining the two systems: Among the K1 negative persons the glaucoma prevalence was lower in the A1-group compared to the O-group (p = 0.003). In the K1 negative group only 9 of 61 A1-persons developed glaucoma, in contrast to the K1 positive group where 4 of 4 A1-persons had glaucoma. This difference gave p < or = 0.00038, whereas the corresponding difference for the O-groups showed p = 0.65. It is concluded that once a person with blood group A1 has developed pseudo-exfoliation syndrome, the risk that capsular glaucoma will occur is about 7 times higher when that person is K1 positive compared to K1 negative. Perhaps this observation may be used as a prognostic factor for non-glaucomatous PE positive persons.

The Middle-Norway eye-screening study. I. Epidemiology of the pseudo-exfoliation syndrome.

This is the first population-based PE prevalence study allowing comparison of observations from different geographical areas. The prevalence of the PE syndrome for persons above 64 years of age was found to be 10.2, 21.0 and 19.6% in three municipalities lying distinctly apart. Of 343 married couples the man was PE-positive in 36, the woman in 34, and both in 12 cases. One of the 12 couples was excluded because the spouses were cousins. The observed number of 11 couples is significantly higher (P = 0.022) than expected assuming independent occurrence of PE syndrome. Two homozygote pairs of twins were found in this material, both of them discordant for the presence of PE syndrome. This fact along with the discrepancy between observed and expected numbers of PE positivity in both spouses may indicate environmental influence on the distribution of the syndrome.

The prevalence of pseudoexfoliation in three separate municipalities of Middle-Norway. A preliminary report.

An epidemiological eye study has been performed in three separate municipalities in the county of South-Trøndelag, Norway. The prevalence of pseudoexfoliation syndrome turned out to be 10.2%, 21.0%, and 19.6% in the respective areas, stating beyond doubt that there are considerable geographic variations in the distribution of this syndrome.