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Cobalt-chromium toxic retinopathy case study.

Warren Apel¹, Denis Stark, Anthony Stark

¹Queensland Health and Princess Alexandra Hospital, and Royal Australian College of Ophthalmologists, Brisbane, Australia. warren.apel@uqconnect.edu.au

Documenta Ophthalmologica. Advances in Ophthalmology

|December 18, 2012

Summary

Cobalt-chromium toxicity from a hip prosthesis caused inner retinal dysfunction in a 65-year-old male. Vision improved after prosthesis revision, but electroretinogram abnormalities persisted, indicating potential long-term effects.

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Area of Science:

Ophthalmology
Toxicology
Biomaterials Science

Background:

Metal-on-metal hip prostheses can release cobalt and chromium ions.
Elevated ion levels are associated with systemic toxicity, but ocular effects are less understood.

Observation:

A 65-year-old male with a hip prosthesis experienced progressive vision loss, poor color vision, and multisystem illness.
Investigations revealed elevated plasma cobalt and chromium, with electroretinogram (ERG) abnormalities indicative of inner retinal dysfunction.

Findings:

Revision surgery to replace the hip prosthesis led to decreased ion levels and improved visual acuity and color vision.
Despite visual recovery, electroretinogram (ERG) abnormalities persisted, suggesting residual inner retinal damage.

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Implications:

This case highlights cobalt-chromium toxicity as a potential cause of inner retinal dysfunction.
Ophthalmologists should consider metal toxicity in patients with unexplained visual disturbances and metallic implants.
Further research is needed to understand the long-term ocular consequences of metal-on-metal joint replacement toxicity.