研究目的
To report on a case of a patient with neuropathy caused by AL amyloidosis and underlying multiple myeloma, and to detect small-fiber damage using confocal cornea microscopy (CCM), which has not been previously shown for this type of neuropathy.
研究成果
The data suggest involvement of the subbasal corneal plexus in AL amyloid neuropathy, indicating small-fiber damage detectable by CCM. This is the first report of such involvement, highlighting CCM as a noninvasive tool for assessing neuropathy in amyloidosis. Further studies are recommended to validate these findings and explore underlying mechanisms.
研究不足
The study is limited by its single-case design, which restricts generalizability. Larger studies with more patients at different stages of multiple myeloma and amyloidosis are needed to confirm findings. The mechanisms of small-nerve fiber damage in the cornea versus epidermis are not fully understood, and potential toxic factors or autoimmune processes require further investigation.
1：Experimental Design and Method Selection:
A case study design was employed, utilizing confocal cornea microscopy (CCM) to assess small-fiber neuropathy in the corneal subbasal plexus, alongside skin biopsy and other diagnostic methods for comparison.
2：Sample Selection and Data Sources:
A single 79-year-old female patient with diagnosed multiple myeloma and amyloid neuropathy was selected based on clinical presentation and laboratory findings. Data were sourced from physical examinations, laboratory tests, biopsies, and CCM imaging.
3：List of Experimental Equipment and Materials:
Heidelberg Retina Tomograph III with Rostock cornea module, GenTeal? eye drops (Théa Pharma), Proparakain-POS?
4：5% (Ursapharm), skin biopsy tools, immunofluorescence staining reagents (anti-PGP 5 and anti-Cy3 conjugated IgG), and ACC-Metrics software Version 0 for image analysis. Experimental Procedures and Operational Workflow:
CCM was performed on the right eye using topical medications, with five images captured. Skin biopsy was conducted on the upper and lower legs, followed by immunofluorescence staining. Electroneurography and nerve biopsy were also performed. Image analysis was done using ACC-Metrics software to quantify corneal nerve parameters.
5：Data Analysis Methods:
Quantitative analysis of corneal nerve fiber length (CNFL), density (CNFD), and branch density (CNBD) was performed using ACC-Metrics software, with results compared to normative values. Statistical methods were not specified due to the single-case nature.
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