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Chameleon-like Appearance of Immunotactoid Keratopathy

Lisch, Walter MD*; Saikia, Parykshit MD*; Pitz, Susanne MD†; Pleyer, Uwe MD‡; Lisch, Christina MD*; Jaeger, Melanie MD§; Rohrbach, Jens M MD¶

doi: 10.1097/ICO.0b013e31821ddd0c
Clinical Science

Purpose: To demonstrate 5 different patterns of immunotactoid keratopathy (ITK) in monoclonal gammopathy of undetermined significance (MGUS) that can mimic hereditary and degenerative disorders. First follow-up of 1 female patient was performed.

Methods: Colored slit-lamp photodocumentation of 6 MGUS light kappa patients with different types of ITK, one patient with a follow-up of 7 years. Systemic and serological examinations of all 6 patients were performed.

Results: The systemic and serological examinations disclosed an MGUS light kappa in all 6 patients. The 7-year follow-up of case 2 showed a reduction of lattice-like opacity to moderate diffuse corneal opacity. Corneal opacity patterns of the 6 patients were as follows: pattern 1, crystalline-like; pattern 2, lattice-like; pattern 3, peripheral granular-like; pattern 4, peripheral band-like; and patterns 5 and 6, peripheral patch-like.

Conclusions: ITK of MGUS can mimic cystinosis, Schnyder corneal dystrophy (CD), pre-Descemet CD, lattice CD, granular CD, arcus lipoides, lecithin-cholesterol acyltransferase deficiency, gelatinous drop-like CD, and Salzmann nodular degeneration. ITK can be the first symptom of MGUS. An annual internal check of MGUS is recommended because of occurrence of a systemic monoclonal gammopathy in 20% of cases.

From the *Private Ophthalmological Office, Hanau; †Department of Ophthalmology, Johannes Gutenberg University of Mainz, Mainz; ‡Department of Ophthalmology, Campus Virchow-Klinikum, Charité Universitaetsmedizin Berlin, Berlin; §Department of Ophthalmology, Justus Liebig University of Giessen, Giessen; and ¶Department of Ophthalmology, Eberhard-Karls University of Tu¨bingen, Tu¨bingen, Germany.

Received for publication April 30, 2010; revision received February 14, 2011; accepted April 2, 2011.

The authors state that they have no financial or conflicts of interest to disclose.

Presented, in part, as a poster at the World Cornea Congress in Boston, 2010.

Reprints: Walter Lisch, Private Ophthalmological Office, Kurt-Blaum-Peatz 8, 63450 Hanau, Germany (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.