[Prognosis of intralenticular lead foreign bodies]

The prognosis of intraocular foreign bodies consisting of lead remains controversial. While experiments have shown that infected lead becomes sterile when fired from rifles, both the total absence as well as presence of severe inflammation have been observed following perforating injuries with lead. Furthermore, alterations of the ERG have been described in experimental settings. This case report is presented in order to clarify the long term prognosis of intralenticular lead particles.

The 69-year-old patient suffered from a bilateral perforating injury caused by a bullet during World War II (1942). The right lens was extracted due to a secondary cataract several weeks following the injury. The left lens remained clear despite a paracentrally located metallic foreign body. The patient underwent extracapsular cataract extraction in 1992 because of an opacity of the posterior capsule which was well separated from the foreign body. Preoperatively the ERG was normal. An energy dispersive X-ray microanalysis in a scanning electron microscope was performed in order to determine the chemical composition of the foreign body, and X-ray diffraction with a Gandolphi camera was used for its structural characterisation. The foreign body consists of lead. However, its surface is probably altered to lead oxide, hydroxide or carbonate, which hindered further reaction of the lead. Calcium phosphate was deposited on the walls of the foreign body.

Our report shows that lead in the lens remains inert for several decades and does not cause alterations in the ERG. Therefore, intralenticular lead outside of the optical axis may be left in situ unless a secondary cataract develops.