Copper Intraocular Foreign Body: Diagnosis and Treatment

[Post-traumatic inflammation with an intraocular foreign body]

BACKGROUND

To report on the diagnosis and management of a"firecracker" injury presenting with a post-traumatic intraocular inflammation.

CASE REPORT

A 10-year-old boy sustained a penetrating 16-mm cornea-sclera blast injury to his left eye with uveal prolapse and hemophthalmus and doubtful light perception. The cranial computed tomography revealed a metallic intraocular foreign body (IOFB), retinal detachment, and subretinal and subchoroidal hemorrhage. After primary wound closure and antibiotic treatment for 1 week, increasing cell infiltration and amaurosis developed, and a lensectomy, pars plana vitrectomy, and extraction of the 17x7x7-mm encapsulated IOFB via a scleral tunnel was indicated.

RESULTS

A vitreous specimen did not reveal microbial growth; however, plenty of polymorphonuclear cells, macrophages, and lymphocytes were observed. Spectroscopy of the IOFB showed copper, zinc, silicon, lead, and other metals. A diagnosis of noninfectious inflammation due to heavy metals, primarily copper (=chalcosis), was made. The postoperative course was unremarkable, the intraocular lens in place, fundus CDR 0.2, retina and macula attached, intraocular pressure 9 mmHg. Three weeks after surgery, the flash VEP showed absent potentials.

CONCLUSIONS

Large projectiles or parts should be removed from the eye immediately in order to prevent complications from toxic metallosis and early fibrotic reactions.

Copper foreign body in the lens without damage of iris and lens capsule

PURPOSE

The objective is to report a rare case of asymptomatic penetrating injury with a copper foreign body found during an examination for cataract surgery.

METHOD

A case report.

RESULTS

A 73-year-old woman had vision loss. Examination by pupil dilation disclosed a dark-brown metallic mass located under the anterior capsule of the lens, as well as nuclear sclerosis of the lens. Although no history of traumatic injury was reported by the patient, careful examination revealed a dot corneal opacity. This finding, and the past history of the patient that she had worked in the fabrication of copper wire, suggested previous penetrating injury. The iris had no scar. No inflammatory reaction was observed in the posterior segment of the eye. Phacoemulsification and implantation of an intraocular lens were performed. After continuous curvilinear capsulorrhexis (CCC), the foreign body was extracted with a microforceps. The anterior capsule overlying the foreign body was intact, with normal light reflex. Qualitative analysis showed that the foreign body extracted contained pure copper at the center. Nevertheless, visual acuity of the right eye improved from 20/50 to 20/20 without any copper-related retinal damage.

CONCLUSION

In this case, copper localized under the anterior capsule of the lens had been able to stay in the eye without causing severe inflammatory reaction.

Late onset of Wilson's disease in a family with genetic haemochromatosis

We report the coexistence of Wilson's disease and genetic haemochromatosis in one family. The diagnosis of genetic haemochromatosis was established in a 52-year-old man. Among his siblings, one 57-year-old sister and one 55-year-old brother had decreased copper and ceruloplasmin levels in serum and increased urinary copper excretion. The sister shared the same human leucocyte antigen haplotypes and was homozygous for the HFE mutation C282Y, like the propositus. However, she had normal liver iron content and increased liver copper content. Her dietary copper intake was probably excessive. The association of Wilson's disease and genetic haemochromatosis is rare and has only been described twice. The onset of Wilson's disease after 50 years of age is rare; Wilson's disease should be considered in any patient with unexplained chronic liver disease; an excess in liver copper content might be induced by excessive dietary input in a susceptible individual.

N-acetyl-serotonin reduces copper (I) ion-induced lipid peroxidation in bovine retinal homogenates

PURPOSE

Chalcosis is an ocular condition caused by penetration injury of copper or its alloy, which leads to extensive ocular inflammation. N-acetyl-serotonin has recently been identified as a potent antioxidant against free radical stress. In this study, we determined the efficacy of N-acetyl-serotonin against the copper (I)-induced retinal lipid peroxidation.

METHODS

Copper (I)-treated (100 microM) bovine retinal homogenates were incubated with 6 different concentrations (i.e. 0.00, 0.25, 0.50, 1.00, 2.00 and 4.00 mM) of N-acetyl-serotonin or vitamin E. The malondialdehyde level was measured as an index of lipid peroxidation.

RESULTS

Copper (I) ions induced a significant dose-dependent increase in malondialdehyde (p=0.007). Co-incubation with N-acetyl-serotonin or vitamin E significantly suppressed the copper (I)-induced malondialdehyde production (p<0.0001). The concentration to inhibit 50% of damage for N-acetyl-serotonin and vitamin E were found to be 1.54 mM and 0.45 mM, respectively.

CONCLUSION

Although N-acetyl-serotonin is only 29% as effective as vitamin E in suppressing the copper (I)-induced lipid peroxidation, the present study supports a pharmacological potential of N-acetyl-serotonin combating free radical oxidative damages in the ocular tissues.