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Cobalt-Chromium Metallosis With Normal Electroretinogram.

Lola M Grillo1, Huy V Nguyen, Stephen H Tsang

  • 1College of Physicians and Surgeons (LG, HVN), Columbia University, New York, New York; Department of Ophthalmology (SHT, DCH, JGO), Columbia University, New York, New York; Department of Pathology and Cell Biology (SHT), Institute of Human Nutrition, and Irving Comprehensive Cancer Center, Columbia University, New York, New York; and Department of Psychology (DCH), Columbia University, New York, New York.

Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society
|June 14, 2016
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Summary

Metal-on-metal hip implants can cause ocular cobalt toxicity, leading to vision loss. This case suggests early-stage optic nerve toxicity, presenting as vision impairment without structural changes on OCT scans.

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Area of Science:

  • Ophthalmology
  • Toxicology
  • Biomaterials Science

Background:

  • Metal-on-metal hip implants are increasingly associated with cobalt toxicity.
  • Ocular manifestations of cobalt toxicity are rare but significant.
  • This study investigates visual loss in a patient with a cobalt-chromium hip implant.

Observation:

  • The patient presented with decreased visual acuity and color vision, along with cecocentral scotomas.
  • Standard electroretinography (ERG) and multifocal ERG (mfERG) showed normal responses.
  • Multifocal visual evoked potentials (mfVEP) revealed decreased central amplitudes, indicating neural dysfunction.

Findings:

  • Optical coherence tomography (OCT) did not reveal structural abnormalities in the retinal nerve fiber layer or ganglion cell layer.
  • The clinical presentation and mfVEP findings suggest toxic optic neuropathy.
  • The toxicity appears to be an early-stage neural dysfunction rather than a structural retinal issue.

Implications:

  • Early diagnosis of ocular cobalt toxicity is crucial for preventing irreversible vision loss.
  • This case highlights the importance of considering metal implant toxicity in patients with unexplained visual disturbances.
  • Further research is needed to understand the progression and long-term effects of ocular cobalt toxicity.