Table 2.
Summary of the published cases presenting with ocular findings due to systemic cobalt toxicity.
| Age (years)/Gender | Pre-revision implant type | Post-revision implant type | C/Cr serum levels (μg/L) | Systemic findings | Ocular findings | Presenting visual acuity | Final visual acuity | |
|---|---|---|---|---|---|---|---|---|
| Steens et al.11 | 53/male | Ceramic on ceramic | Ceramic on metal | C: 398 Cr: 56 | Hearing loss, paresthesias | Optic atrophy and retinopathy both eyes | Could just recognize outlines and colors but could not read | Able to work on computer with strong glasses |
| Rizzetti et al.9 | 58/female | Ceramic on ceramic | Metal on polyethylene | C: 549 Cr: 54 |
Hearing loss, lower limb hyposthenia | MRI: Hyperintensity of optic nerves and tracts, VEP: abnormal both eyes | Not provided | Not provided |
| Tower et al.12 | 49/male | Metal on metal | Non-metal on metal | C: 35-122 Cr: 28-63 |
Cognitive disturbances, hearing loss, dyspnea, diastolic dysfunction, sleep apnea | Optic atrophy (eye not provided) | Not provided | Not provided |
| Apel et al.13 | 65/male | Ceramic on ceramic | Ceramic on metal | C: 446.4 Cr: 46 |
Malaise, cardiomyopathy, bulbar palsy, hypothyroidism | Poor visual acuity and color vision, ERG: abnormal both eyes | Right eye: 6/60 Left eye: 6/36 |
Right eye: 6/6 Left eye: 6/9 |
| Ng et al.14 | 39/female | Metal on metal | Not provided | C: 44.7 Cr: 30.9 |
Nausea, metallic taste | Bilateral ocular discomfort, photoreceptor-retinal pigment epithelium degeneration, paracentral scotoma, ICG: left eye chorioretinal, hypofluorescent lesions | Both eyes: 20/16 | Both eyes: 20/16 |
| Dahms et al.15 | 55/male | Ceramic on ceramic→ Metal on polyethylene |
Ceramic (unspecified) | C: 885 Cr: 49 |
Heart failure, hearing loss, hypothyroidism | Vision loss (eye not provided) | Not provided | Not provided |
| Harris et al.8 | 57/female | Ceramic on ceramic | Metal on polyethylene | C: 788.1 Cr: 140 |
Hip pain, fatigue, memory loss, lower extremity sensory loss, persistent tachycardia | Reduced visual acuity, subjective non-specific visual changes (eye not provided) | Not provided | Not provided |
| Grillo et al.6 | 66/male | Ceramic on ceramic | Metal on metal | C: 1078 Cr: not provided | Hearing loss, abdominal distention and ankle swelling, left hip pain, diarrhea, rash, incoordination, cognitive difficulties | Decreased visual acuity, poor color vision, and cecocentral scotoma left eye, ERG: normal | Right eye: 20/80 (History of amblyopia) Left eye: 20/30 |
Right eye: 20/80 (History of amblyopia) Left eye: 20/25 |
| Peters et al.17 | 71/male | Ceramic on ceramic | Metal on polyethylene | C: 596.5 Cr: 48.8 |
Abdominal pain, vomiting, diarrhea, hearing loss, visual impairment, vertigo, unintentional weight loss, hypothyroidism, cardiomyopathy | Nonspecific visual impairment (eye not provided) | Not provided | Not provided |
| Ho et al.16 | 63/male | Ceramic on ceramic | Not provided | C: 280-779 Cr: not provided |
Hearing loss, painful paresthesias, cardiomyopathy | Decreased visual acuity both eyes, MRI: hyperintensity of optic nerves | Right eye: 20/80 Left eye: 20/200 |
Both eyes: Count fingers |
| Weber et al.18 | 66/female | Ceramic (unspecified) | Metal on polyethylene | C: 411.5 Cr: not provided |
Depression, fatigue, unintentional weight loss, paresthesias, disequilibrium, hearing loss, cardiomyopathy | Decreased visual acuity with central scotomas both eyes, mild right relative afferent pupillary defect, ERG: severe cone dysfunction and low normal rod function | Both eyes: Count fingers | Both eyes: Count fingers |