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PHOTO ESSAY
Year : 2019  |  Volume : 67  |  Issue : 11  |  Page : 1878-1879

Ultra-widefield imaging of golden vitreous membranes requiring pars plana vitrectomy in a case of chronic ocular chalcosis


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Submission04-Mar-2019
Date of Acceptance30-Jun-2019
Date of Web Publication22-Oct-2019

Correspondence Address:
Dr. M Dheepak Sundar
House No 6, (Dinesh Saini) 1st Floor, Gautam Nagar, Delhi – 110 049
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_433_19

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Keywords: Copper, foreign body, ocular chalcosis, vitreous membranes


How to cite this article:
Sundar M D, Ayyadurai N, Chawla R, Hasan N. Ultra-widefield imaging of golden vitreous membranes requiring pars plana vitrectomy in a case of chronic ocular chalcosis. Indian J Ophthalmol 2019;67:1878-9

How to cite this URL:
Sundar M D, Ayyadurai N, Chawla R, Hasan N. Ultra-widefield imaging of golden vitreous membranes requiring pars plana vitrectomy in a case of chronic ocular chalcosis. Indian J Ophthalmol [serial online] 2019 [cited 2019 Nov 22];67:1878-9. Available from: http://www.ijo.in/text.asp?2019/67/11/1878/269634



A 43-year-old male who had sustained a blast injury involving a finch air conditioner 5 years earlier presented to us with insidious progressive loss of vision in the left eye with a best-corrected visual acuity (BCVA) of 20/80. He had a corneal opacity near temporal limbus with a peripheral iris defect suggestive of the penetrating entry wound tract and a sunflower cataract [Figure 1]a. Yellowish dotted vitreous membranes with clumping were visible posterior to the lens [Figure 1b]. On fundus examination, a foreign body (FB) was seen in the inferior vitreous cavity with irregular golden vitreous membranes emanating from the site [Figure 2]. Noncontrast computed tomography showed an FB of size measuring 1.2 mm × 0.9 mm. Electro-retinography showed diminished a and b waves when compared with the other eye. The patient was diagnosed to have left eye vitreous opacification secondary to chronic ocular chalcosis and underwent phacoemulsification with intraocular lens implantation and pars plana vitrectomy with FB removal. On densitometry, copper content was found to be 60%. On 6 weeks' follow-up, he had a BCVA of 20/30.
Figure 1: Anterior segment photography of the affected eye with ocular chalcosis. (a) Diffuse illumination showing sunflower-shaped anterior capsular opacities with a central disc and peripheral spikes. The foreign body entry wound is seen as an iris hole (arrow). (b) Retro illumination of the anterior vitreous showing yellowish golden fibrillary membranes

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Figure 2: Ultra-widefield imaging of golden vitreous fibrils in the inferior vitreous emanating from the foreign body. The dandelion seed-like vitreous clumping at the foreign body site is evident (arrow)

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Ocular chalcosis is known to cause pathological vitreous changes. Rosenthal et al. described fibrillary degeneration of vitreous in cases, when copper was lodged in the vitreous cavity for a longer time period. Clumping of degenerated vitreous with copper deposition near the FB site was also noted.[1] Moster and Synekwith the help of ultra-structural electron microscopy have suggested that copper has heterogeneous affinity for collagen fibrils leading to conglomerations or irregular accumulations over the fibrillary vitreous.[2] These findings are different from siderosis bulbi. An iron FB can cause lamellar, asteroid-like, or strip-like opacification of vitreous with brownish discoloration.[3] Fibrillary degeneration and dandelion seed-like clumping near the FB site may be considered characteristic of a copper FB.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rosenthal AR, Marmor MF, Leuenberger P, Hopkins JL. Chalcosis: A study of natural history. Ophthalmology 1979;86:1956-72.  Back to cited text no. 1
    
2.
Moster MF, Synek S. Pathogenesis of disorders of transparency of the optic media of the eye. III. Quantitative detection of copper in relation to the ultrastructure of the vitreous body in chalcosis. Ceskoslovenskaoftalmologie 1989;45:177-86.  Back to cited text no. 2
    
3.
Xie H, Chen S. Ocular siderosis. Eye Sci 2013;28:108-12.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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