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      Ophthalmic Manifestations of Multiple Myeloma

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          Purpose: To describe ophthalmic manifestations in a series of patients with multiple myeloma (MM) and review the literature. Design: Retrospective case series. Methods: Review of all cases with ophthalmic manifestations of MM seen at the Department of Ophthalmology, Royal Adelaide Hospital, between 1987 and 2002. Results: Of all patients with MM who were managed at the Royal Adelaide Hospital in the study period, only 8 were referred to the Ophthalmology Department with ophthalmic manifestations. Five males and 3 females with a mean age of 61.25 years (range 42–78) who exhibited ophthalmic manifestations were studied. Six patients (75%) had known MM at the time of their ophthalmic evaluation. Four patients (50%) had neuro-ophthalmic symptoms resulting in diplopia or visual disturbances. Three patients (37.5%) presented with orbital involvement and 1 (12.5%) with hyperviscosity retinopathy. Five patients (62.5%) died within 2 months of their ophthalmic presentation. Conclusion: Ophthalmic manifestations of MM are uncommon and diverse. They may appear at the initial presentation of the disease or occur late in the disease process. Awareness of the possible manifestations may lead to an earlier diagnosis and have a positive influence on the disease course.

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          Most cited references 11

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          Necrobiotic xanthogranuloma: long-term outcome of ocular and systemic involvement.

          To report long-term outcomes of patients with necrobiotic xanthogranuloma, to investigate the propriety of therapeutic surgical excision or debulking, and to study tissue specimens by immunoperoxidase staining and in situ hybridization. Medical records of all patients at the Mayo Clinic, Rochester, Minnesota, with necrobiotic xanthogranuloma between 1980 and 1997 were reviewed. A follow-up letter was sent to each patient inquiring about the current status of the lesions, the treatment regimen, and associated systemic diseases. The average age (+/- standard deviation) of the 15 men and 11 women was 56.8 +/- 14.8 years. Of the 26 patients, 21 (81%) had lesions of the ocular adnexa. Ulceration of the lesions occurred in 11 patients (42%). The lesions recurred after surgical removal in 11 patients (42%) and on prior incision sites from unrelated operations in three patients (12%). The average duration of follow-up from the appearance of characteristic skin lesions was 10 +/- 6.1 years. Four patients had multiple myeloma, five had a plasma cell dyscrasia, and one had a lymphoproliferative disorder during this period. Time to development of associated malignancy ranged from 8 years before the skin lesions to 11 years after the skin lesions. Overall survival was 100% at 10 years and 90% at 15 years (95% confidence limit, 0.73 to 1.00). Immunoperoxidase stains demonstrated that most histiocytes are not of Langerhans cell lineage. Monoclonal immune globulins were not identified in tissue specimens. Care of patients with necrobiotic xanthogranuloma should include avoidance of surgical removal, if possible, and lifelong follow-up to detect the development of associated malignancy.
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            Ocular manifestations of multiple myeloma, Waldenström's macroglobulinemia and benign monoclonal gammopathy.

            Multiple myeloma, Waldenström's macroglobulinemia and benign monoclonal gammopathy are examples of diseases in which there is an uncontrolled proliferation of cells involved in antibody synthesis. Myeloma and macroglobulinemia are considered malignant diseases, whereas monoclonal gammopathy is benign or possibly a pre-myelomatous condition. Following a brief review of the immunoglobulins the various clinical manifestations of these disorders are described. The ophthalmic signs of these disorders can be seen in every ocular structure.
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              Isolated cotton-wool spots in a 67-year-old woman.

               M Shami,  R N Uy (1996)
              An elderly woman presented for evaluation of the recent onset of a fixed, blurry circle in the right eye. Visual acuity was 20/20 OU. Funduscopic examination revealed a newly-noticed isolated cotton-wool spot in each eye. Amsler grid testing revealed an arcuate shady area in the inferior nasal field. A thorough systemic and laboratory evaluation led to the diagnosis of multiple myeloma. The evaluation of an isolated cotton-wool spot found on funduscopic examination in the absence of diabetes and hypertension is discussed.

                Author and article information

                S. Karger AG
                February 2005
                06 January 2005
                : 219
                : 1
                : 43-48
                Oculoplastic and Orbital Unit, Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
                81782 Ophthalmologica 2005;219:43–48
                © 2005 S. Karger AG, Basel

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                Page count
                Figures: 2, Tables: 1, References: 31, Pages: 6
                Original Paper

                Vision sciences, Ophthalmology & Optometry, Pathology

                Multiple myeloma, Ophthalmic manifestations


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