Atypical corneal immunoglobulin deposition in a patient with dysproteinemia

Purpose: The purpose of this study was to report an unusual pattern of immunoglobulin deposition in the corneas of a patient with dysproteinemia. Methods: Clinical examination, slit lamp examination, a deep lamellar corneal biopsy, and serum and aqueous protein electrophoresis were obtained. Results: Slit lamp evaluation revealed amorphous, cloud-like opacities in the midperiphery at the level of deep stroma and Descemet's membrane. Electron microscopy demonstrated deep lamellar extracellular deposits consistent with immunoglobin. The serum protein electrophoresis revealed a monoclonal IgG kappa band, but the aqueous electrophoresis showed no bands in the gamma region. Conclusion: This case documents a rare pattern of immunoglobulin deposition in the corneas in a patient with gammopathy. Despite its deep corneal distribution, the analysis of the aqueous specimen suggests that the source of the immunoglobulin is through a route other than from the aqueous.