RESUMEN
PURPOSE: To report the clinical case of a 65-year-old male who developed retinal dysfunction following cobalt-chromium toxicity. METHODS: A review of the clinical, haematological, radiological and electrophysiological investigations into a single patient was performed in order to form a case report. RESULTS: A 65-year-old male presented to his ophthalmologist with a 1-year history of worsening vision on the background of a multisystem illness including motor axonopathy, pericardiomyopathy and bulbar palsy. His medical history included hypertension, hypercholesterolaemia and a metallic hip prosthesis. Ocular examination revealed significantly reduced visual acuity bilaterally along with very poor colour vision. Cornea, fundi and optic discs all appeared normal. Bilateral moderate nuclear sclerosis was noted. Basic investigations including mitochondrial studies, auto-immune screen and MRI of brain were unremarkable. Further investigations showed significantly elevated plasma cobalt and chromium levels. Electrophysiological studies revealed an abnormality in all phases of the ERG including a negative b-waveform, suggestive of inner retinal pathology. Following subsequent revision of the hip, cobalt and chromium levels decreased and the patient's vision improved. Further electrophysiological testing indicates a persistent ERG abnormality despite a significant improvement in both the patient's visual acuity and colour vision. CONCLUSIONS: These results suggest that cobalt-chromium toxicity can cause inner retinal dysfunction.
Asunto(s)
Aleaciones de Cromo/envenenamiento , Potenciales Evocados Visuales/efectos de los fármacos , Retina/efectos de los fármacos , Enfermedades de la Retina/inducido químicamente , Anciano , Artroplastia de Reemplazo de Cadera , Electrorretinografía , Prótesis de Cadera/efectos adversos , Humanos , Masculino , Retina/patología , Retina/fisiopatología , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/fisiopatología , Agudeza VisualRESUMEN
We report on six cases of metallosis which developed in bipolar hip prosthesis due to ceramic screws used for fixation of bone grafts. Two patients experienced severe metallosis due to abnormal abrasion of the femoral head. At the revision surgery, proliferated black synovia was found. Analyses of the retrieved prostheses revealed numerous small particles of alumina ceramic on the inner surface of the bearing insert of UHMWPE. These particles came from the broken ceramic screws, and scraped away the metallic femoral head resulting in severe metallosis. In four patients, the outer head came into direct contact with ceramic screws and mild metallosis was observed at revision surgery.