RESUMEN
The dense accumulation of copper in Descemet membrane and lens capsule is the characteristic manifestation of a circulating monoclonal antibody with strong affinity for copper. The overproduction of this monoclonal immunoglobulin may be associated with either multiple myeloma or a benign monoclonal gammopathy. Despite prolonged exposure to elevated serum copper, no other tissues in the body are adversely affected by this redox metal. We describe the clinical and pathological findings in a 46-year-old woman with this disorder.
Asunto(s)
Cápsula Anterior del Cristalino/metabolismo , Cobre/metabolismo , Enfermedades de la Córnea/diagnóstico , Lámina Limitante Posterior/metabolismo , Enfermedades del Cristalino/diagnóstico , Gammopatía Monoclonal de Relevancia Indeterminada/diagnóstico , Extracción de Catarata , Ceruloplasmina/metabolismo , Enfermedades de la Córnea/metabolismo , Enfermedades de la Córnea/cirugía , Queratoplastia Endotelial de la Lámina Limitante Posterior , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades del Cristalino/sangre , Enfermedades del Cristalino/cirugía , Implantación de Lentes Intraoculares , Persona de Mediana Edad , Gammopatía Monoclonal de Relevancia Indeterminada/sangre , Mieloma Múltiple/diagnóstico , Espectrometría por Rayos XRESUMEN
AIMS/BACKGROUND: To identify an HLA association with pseudoexfoliation of the lens capsule to support the hypothesis that there is a genetic predisposition to pseudoexfoliation. A randomised trial would be ideal for establishing a relation but is more costly and time consuming to conduct. Case-control studies provide an alternative method of establishing a relation. METHODS: The study group comprised 128 subjects who presented to a major eye centre with pseudoexfoliation. Data from blood donors representative of the population of Ireland were used to form a control group. RESULTS: An HLA association with pseudoexfoliation is identified for 14 antigens. Eleven antigens (HLA A1, A33, B8, B47, B51, B53, B57, B62, DR3, DR12, and DR13) are significantly more common in the pseudoexfoliation group while three antigens (HLA B12, B17, and DR2) are significantly less common. Four HLA antigens are strongly associated, with odds ratios of over 7.5. CONCLUSION: The strength of this HLA association is supportive evidence for a genetic component to the development of pseudoexfoliation of the lens capsule.