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

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

doi:10.1016/j.ajoc.2025.102369

American Journal of Ophthalmology Case Reports (Sep 2025)

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

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

Affiliations

Aim-On Saengsirinavin: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA; Department of Ophthalmology, Police General Hospital, Bangkok, Thailand
Jia-Horung Hung: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
Anadi Khatri: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
Celine Dan-Tam Nguyen: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA; Southwestern Medical School, Dallas, TX, USA
Pamok Seangsirinavin: Department of Orthopedics, Police General Hospital, Bangkok, Thailand
Frances Andrea Anover: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
Negin Yavari: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
Dalia El-feky: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
Ngoc Trong Tuong Than: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
Osama Elaraby: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
Xiaoyan Zhang: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
Anh Ngoc Tram Tran: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
Cigdem Yasar: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
Azadeh Mobasserian: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
Irmak Karaca: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
Amir Akhavanrezayat: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
Chi Mong Christopher Or: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
Quan Dong Nguyen: Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA; Corresponding author. Spencer Center for Vision Research, Byers Eye Institute at Stanford University, 2452 Watson Court, Suite 200, Palo Alto, CA, 94303, USA.

DOI: https://doi.org/10.1016/j.ajoc.2025.102369
Journal volume & issue: Vol. 39
p. 102369

Abstract

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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.

Published in American Journal of Ophthalmology Case Reports

ISSN: 2451-9936 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Ophthalmology
Website: https://www.sciencedirect.com/journal/american-journal-of-ophthalmology-case-reports

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