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

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 [Fig. 1a]. Yellowish dotted vitreous membranes with clumping were visible posterior to the lens [Fig. 1b]. On fundus examination, a foreign body (FB) was seen in the inferior vitreous cavity with irregular golden vitreous membranes emanating from the site [Fig. 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

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)

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 Synek with 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.

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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.

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Conflicts of interest

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