• cornea
• paraproteins
• thalidomide
• myeloma

A 64 year old man presented to the corneal service complaining of glare at night which had worsened over a 12 month period. He was found to have a pancorneal epithelial crystalline keratopathy with normal Snellen acuity (6/5 both eyes) and an otherwise unremarkable ocular examination (anterior chamber, lens, vitreous, and fundus). The crystalline keratopathy stretched from limbus to limbus and consisted of a homogeneous spread of tiny yellow crystals located in the epithelium and to a lesser extent the anterior corneal stroma. Two months later, following investigation for breathlessness he was diagnosed as suffering from multiple myeloma. Investigations revealed a raised plasma viscosity (3.28 cp), an IgG-κ paraprotein (55.9 g/l), free immunoglobulin light chains in the urine (0.49 g/24 hours), a hypercellular bone marrow aspirate (70–80% plasma cells), and a single lytic bone lesion in the left iliac crest.

He was entered into the MRC Myeloma Trial (Myeloma VII) and was randomised to receive ABCM (adriamycin, BCNU, cyclophosphamide, melphalan). However, his renal function rapidly deteriorated (creatinine 714) requiring plasma exchange. Seven courses of ABCM were completed before the myeloma reached plateau phase (paraprotein 27.1 g/l) at which point interferon alfa was begun as maintenance therapy. Seven months later, …