Cobalt-induced Retinopathy: Unveiling the hidden risk of knee prosthesis

Q3 Medicine

American Journal of Ophthalmology Case Reports Pub Date : 2025-06-27 DOI:10.1016/j.ajoc.2025.102369

Aim-On Saengsirinavin , Jia-Horung Hung , Anadi Khatri , Celine Dan-Tam Nguyen , Pamok Seangsirinavin , Frances Andrea Anover , Negin Yavari , Dalia El-feky , Ngoc Trong Tuong Than , Osama Elaraby , Xiaoyan Zhang , Anh Ngoc Tram Tran , Cigdem Yasar , Azadeh Mobasserian , Irmak Karaca , Amir Akhavanrezayat , Chi Mong Christopher Or , Quan Dong Nguyen

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引用次数: 0

Abstract

Purpose

To report a case of cobalt-induced retinopathy from a knee prosthesis and to outline the diagnostic challenges and management approach.

Observation

A 67-year-old female presented with chronic bilateral visual disturbances, including blurred vision and photopsia, which began shortly after receiving a cobalt-containing knee prosthesis (DePuy Sigma Total Knee System, recalled by FDA in 2014, Recall No. Z-0423-2014). Ophthalmic evaluation revealed bilateral chorioretinitis, cystoid macular edema, and optic disc inflammation. Removal of the cobalt-containing prosthesis, along with aggressive immunosuppressive therapy, led to significant improvement in visual acuity and retinal function, as confirmed by fluorescein angiography, electroretinography, and Goldmann visual field testing.

Conclusion

This case adds to the limited literature on cobalt-induced retinopathy by demonstrating that even small prosthetic implants, such as knee prostheses, can lead to systemic cobalt toxicity with significant ocular complications. Early diagnosis, combined with prompt removal of the affected prosthesis and management of inflammation, is crucial for restoring vision and preventing further damage.

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钴致视网膜病变：揭露膝关节假体的潜在风险

目的报告一例膝关节假体钴致视网膜病变，并概述诊断挑战和治疗方法。一名67岁女性患者，在接受含钴膝关节假体（DePuy Sigma全膝关节系统，2014年被FDA召回，召回号：No. 5）后不久，出现慢性双侧视力障碍，包括视力模糊和失光。z - 0423 - 2014)。眼科检查显示双侧脉络膜视网膜炎、囊样黄斑水肿和视盘炎症。通过荧光素血管造影、视网膜电图和Goldmann视野测试证实，摘除含钴假体并配合积极的免疫抑制治疗可显著改善视力和视网膜功能。该病例增加了关于钴诱导视网膜病变的有限文献，表明即使是小的假体植入物，如膝关节假体，也可能导致全身钴毒性并伴有明显的眼部并发症。早期诊断，结合迅速移除受影响的假体和处理炎症，对于恢复视力和防止进一步损害至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Ophthalmology Case Reports Medicine-Ophthalmology

CiteScore

2.40

自引率

0.00%

发文量

513

审稿时长

16 weeks

期刊介绍： The American Journal of Ophthalmology Case Reports is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished case report manuscripts directed to ophthalmologists and visual science specialists. The cases shall be challenging and stimulating but shall also be presented in an educational format to engage the readers as if they are working alongside with the caring clinician scientists to manage the patients. Submissions shall be clear, concise, and well-documented reports. Brief reports and case series submissions on specific themes are also very welcome.