Cobalt-Chromium Metallosis With Normal Electroretinogram

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Title Cobalt-Chromium Metallosis With Normal Electroretinogram
Creator Lola M. Grillo, BA; Huy V. Nguyen, MD; Stephen H. Tsang, MD, PhD; Donald C. Hood, PhD; Jeffrey G. Odel, MD
Affiliation College 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
Abstract Ocular cobalt toxicity is a rare phenomenon reported with increased frequency due to the rise of cobalt-chromium metal hip implants. We report the case of a 66-year-old previously healthy man who developed decreased vision due to cobalt-chromium toxicity from a metal-on-metal hip arthroplasty. Our objective was to determine whether the origin of his visual loss was due to toxicity of the optic nerve, of the retina, or of both.; Ocular examination, 10-2 SITA-Standard Humphrey Visual Field (VF), standard full-field electroretinogram (ERG) as indicated by the International Society for Clinical Electrophysiology of Vision (ISCEV), multifocal electroretinogram (mfERG), multifocal visual evoked potentials (mfVEP), and optical coherence tomography (OCT) were conducted.; Ocular examination revealed decreased visual acuity, poor color vision, normal funduscopy, and cecocentral scotomas on VF testing. Because his right eye was amblyopic since childhood, test results from only the left eye are shown. Electrophysiology studies revealed an ISCEV standard full-field ERG with photopic and scotopic responses within normal limits, mfERG with amplitudes and latencies within normal limits, and mfVEP with latencies within normal limits, but with decreased central amplitudes. Peripapillary and macular OCT showed retinal nerve fiber layer and retinal ganglion cell-inner plexiform layer thickness within normal limits.; Because decreased color vision and cecocentral scotoma on 10-2 VF are most consistent with toxic optic neuropathy, and decreased central amplitudes on mfVEP are suggestive of neural dysfunction, we hypothesize that our patient presented with an early stage of optic nerve toxicity that was not yet apparent as a structural abnormality on OCT.
Subject Older people; Chromium Alloys; Electroretinography; Hip Prosthesis; Humans; Male; Retina; Retinal Diseases; Tomography, Optical Coherence; Visual Acuity
OCR Text Show
Date 2016-12
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, December 2016, Volume 36, Issue 4
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6546m4z
Setname ehsl_novel_jno
ID 1293149
Reference URL https://collections.lib.utah.edu/ark:/87278/s6546m4z
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