Abstract
Purpose :
Patients with plasma cell disorders are frequently affected by peripheral neuropathy due to disease progression or therapeutic intervention. Currently, neuropathic progression is clinically surveyed by patient symptoms and testing decreased sensation to vibration with the Rydel and Seiffer tuning fork. Herein we comparatively analysed the presence of clinical neuropathic symptoms with morphological changes detected by non-invasive in vivo confocal laser scanning microscopy (CLSM) in multiple myeloma (MM) patients (n=16).
Methods :
Sensible nerve function of multiple myeloma patients was evaluated by testing of feet and legs sensation to vibration with Rydell and Seiffer tuning fork, monofilament and temperature sensation as well as the Achilles tendon reflex. The assessment included the neuropathy symptom score (NNS), neuropathy deficit score (NDS) and Michigan neuropathy screening instrument (MNSI). Additionally, non-invasive CLSM of the corneal subbasal nerve plexus of one eye and a testing of corneal sensitivity of both eyes with Cochet-Bonnet Esthesiometer was performed. The patients were analysed at the time points: at Diagnosis, 3 month, 6 month, 12 month after start of therapy.
Results :
In our ongoing study imaging of the corneal subbasal nerve plexus with CLSM revealed different morphological and nerve fibre changes as focal nerve fiber hypertrophy and diffuse or multiple bud-like paranerval hyperreflecivities. These changes were detected in the majority of the screened patients developing within disease course and treatment. Interestingly these changes were absent or mild at the respective initial diagnosis time points. In the same investigation period the majority of patients presented up with increased peripheral neuropathy symptoms.
Conclusions :
CLSM allowed identifying different morphological patterns within the layer of corneal subbasal nerve plexus in MM patients. The observed changes appear to be unique with paraproteinemias. As a correlation of the neuropathic symptoms and imaging was possible the employment of CLSM qualifies as a methodical approach for early detection of morphological changes during MM course and treatment.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.