Corneal cupremia in multiple myeloma: a clinicopathologic correlation.

ReportofaCase.A71-year-oldwhitewomanwithan8-year history of refractory multiple myeloma had blurred vision. Herbest-correctedvisualacuitywas20/30OU.Inbotheyes, the cornea manifested a remarkable golden-brown, metallic sheen that on slitlamp examination was determined to be at the level of the Descemet membrane (Figure1). The remainder of her examination disclosed no abnormalities. Several months later, the patient’s vision rapidly decreased andshewasdiagnosedwithmucormycosisof theorbit and sinus. Despite aggressive sinus and orbit débridement as well as theuseof antifungal agents, thepatient requiredexenteration. The exenteration specimen provided a unique opportunity to study her eye. Light microscopy demonstrated slightly granular, tan pigmentation of the anterior portion of the Descemet membrane in the central cornea. Copper-specific staining with rubeanic acid showed highly positive staining of the central cornea, primarily in the anterior Descemet membrane with some additional granular staining of the posterior Descemet membrane (Figure 2). Similar stains of the midperipheral and peripheral cornea revealed that copper was absent from these regions. No copper deposition was noted in the lens capsule as has been previously reported.