Background: Corneal imaging may support an early diagnosis of monoclonal gammopathy.
The goal of our study was to analyze corneal stromal properties using Pentacam and in vivo confocal
cornea microscopy (IVCM) in subjects with monoclonal gammopathy. Patients and methods: In our
cross-sectional study, patients with monoclonal gammopathy (130 eyes of 65 patients (40.0% males;
age 67.65 ± 9.74 years)) and randomly selected individuals of the same age group, without hematological disease (100 eyes of 50 control subjects (40.0% males; age 60.67 ± 15.06 years)) were included.
Using Pentacam (Pentacam HR; Oculus GmbH, Wetzlar, Germany), corneal stromal light scattering
values were obtained (1) centrally 0–2 mm zone; (2) 2–6 mm zone; (3) 6–10 mm zone; (4) 10–12 mm
zone. Using IVCM with Heidelberg Retina Tomograph with Rostock Cornea Module (Heidelberg
Engineering, Heidelberg, Germany), the density of hyperreflective keratocytes and the number
of hyperreflective spikes per image were manually analyzed, in the stroma. Results: In the first,
second and third annular zone, light scattering was significantly higher in subjects with monoclonal
gammopathy, than in controls (p ≤ 0.04). The number of hyperreflective keratocytes and hyperreflective spikes per image was significantly higher in stroma of subjects with monoclonal gammopathy
(p ≤ 0.012). Conclusions: Our study confirms that increased corneal light scattering in the central
10 mm annular zone and increased keratocyte hyperreflectivity may give rise to suspicion of monoclonal gammopathy. As corneal light scattering is not increased at the limbal 10–12 mm annular
zone in monoclonal gammopathy subjects, our spatial analysis provides evidence against the limbal
origin of corneal paraprotein deposition. Using IVCM, stromal hyperreflective spikes may represent
specific signs of monoclonal gammopathy