Ocular crystal deposition leading to a diagnosis of multiple myeloma: a report of 2 cases and review of the literature
Bibliographic record
Abstract
Corneal crystal deposition due to multiple myeloma is a rare ocular manifestation caused by elevated immunoglobulin levels in the eye. It presents with decreased visual acuity and crystalline deposits in the corneal epithelium or stroma. We describe here two cases of myeloma crystal deposition in the eye, one of which involved crystal deposition in a Laser-Assisted in situ Keratomileusis (LASIK) interface, and one that demonstrated rapid and complete response of corneal crystals with induction chemotherapy (to our knowledge, the first such cases in the literature). We also present a brief review of the literature. A 50-year-old woman presented with decreased vision and crystal deposition in her LASIK interface. This led to a diagnosis of IgG multiple myeloma and treatment with melphalan and prednisone improved her vision to 20/20, but did not completely resolve the corneal crystals. Similarly, a 53-year-old woman presented with foggy vision and dense ocular crystalline deposits. Work-up revealed smoldering myeloma, and the patient was managed conservatively until she developed end-organ damage including anemia and lytic bone lesions. Systemic therapy was initiated, and the crystal deposits resolved completely. With these cases, we hope that clinicians will recognize these unusual ocular manifestations, and consider myeloma in the differential diagnosis. Further research is warranted, but in light of the observed response to therapy and the significant patient burden associated with vision loss, it may be prudent to consider systemic therapy for myeloma-associated ocular disease (though this is not the current convention), potentially with bortezomib.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.009 | 0.006 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".