RESUMO
The dense accumulation of copper in Descemet membrane and lens capsule is the characteristic manifestation of a circulating monoclonal antibody with strong affinity for copper. The overproduction of this monoclonal immunoglobulin may be associated with either multiple myeloma or a benign monoclonal gammopathy. Despite prolonged exposure to elevated serum copper, no other tissues in the body are adversely affected by this redox metal. We describe the clinical and pathological findings in a 46-year-old woman with this disorder.
Assuntos
Cápsula Anterior do Cristalino/metabolismo , Cobre/metabolismo , Doenças da Córnea/diagnóstico , Lâmina Limitante Posterior/metabolismo , Doenças do Cristalino/diagnóstico , Gamopatia Monoclonal de Significância Indeterminada/diagnóstico , Extração de Catarata , Ceruloplasmina/metabolismo , Doenças da Córnea/metabolismo , Doenças da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Diagnóstico Diferencial , Feminino , Humanos , Doenças do Cristalino/sangue , Doenças do Cristalino/cirurgia , Implante de Lente Intraocular , Pessoa de Meia-Idade , Gamopatia Monoclonal de Significância Indeterminada/sangue , Mieloma Múltiplo/diagnóstico , Espectrometria por Raios XRESUMO
AIMS/BACKGROUND: To identify an HLA association with pseudoexfoliation of the lens capsule to support the hypothesis that there is a genetic predisposition to pseudoexfoliation. A randomised trial would be ideal for establishing a relation but is more costly and time consuming to conduct. Case-control studies provide an alternative method of establishing a relation. METHODS: The study group comprised 128 subjects who presented to a major eye centre with pseudoexfoliation. Data from blood donors representative of the population of Ireland were used to form a control group. RESULTS: An HLA association with pseudoexfoliation is identified for 14 antigens. Eleven antigens (HLA A1, A33, B8, B47, B51, B53, B57, B62, DR3, DR12, and DR13) are significantly more common in the pseudoexfoliation group while three antigens (HLA B12, B17, and DR2) are significantly less common. Four HLA antigens are strongly associated, with odds ratios of over 7.5. CONCLUSION: The strength of this HLA association is supportive evidence for a genetic component to the development of pseudoexfoliation of the lens capsule.