The Montgomery Lecture, 1979. Ocular metallosis

Area of Science:

• Ophthalmology
• Toxicology
• Biochemistry

Background:

• Metallotic damage to the eye results from redox processes and complex biochemical reactions.
• Siderosis typically presents a chronic course, while chalcosis can vary in severity and timing.
• Previous understanding of chalcosis was based on rarer chronic cases without fibrotic reactions.

Purpose of the Study:

• To analyze the clinical course and characteristics of metallotic damage, specifically chalcosis, from copper-containing foreign bodies in the vitreous.
• To compare the presentation of chalcosis with siderosis.
• To evaluate the impact of vitreous fibrosis and retinal detachment on treatment outcomes.

Main Methods:

• Retrospective analysis of 282 cases involving copper-containing foreign bodies in the vitreous.
• Clinical observation of the timing, severity, and characteristics of metallotic damage.
• Assessment of cellular reactions, including fibrosis, and treatment outcomes following vitrectomy.

Main Results:

• In 68% of cases with copper foreign bodies, chalcosis presented as subacute, acute, or fulminating.
• Chronic chalcosis was observed in less than half of the remaining 32% of cases.
• Acute chalcosis is characterized by significant cellular reactions, particularly fibrosis, and can lead to severe vitreous fibrosis and retinal detachment.

Conclusions:

• Copper-containing foreign bodies in the vitreous predominantly lead to acute or subacute chalcosis, differing from the chronic nature of siderosis.
• Vitrectomy is a treatment option for severe vitreous fibrosis and retinal detachment, but outcomes are guarded due to the pre-phthisic stage of affected eyes.
• A significant number of enucleations are still required despite surgical intervention for advanced metallotic damage.