P 91Intraocular copper foreign body without verification of computer tomography and magnetic resonance tomography
S. Walter, U. Schmidt, R. Fiedler, W. Lieschke, J. Kuchenbecker
Although modern imaging techniques for diagnostic evaluation of metallic foreign bodies (FB) are available today, not all FB can be visualized and verified by those techniques.
Case report: In March 1998 an 11-year old boy played with a metal wire, which perforated his left eye. Two days later he was seen for the first time by an ophthalmologist. In the following months he impressed multiple times with uveitis. He had always full visual acuity and was treated with antiphlogistic topical medication. In November 1999 he developed an iris tumor and progressive loss of visual acuity.
Clinical findings: A magnetic resonance tomogram did reveal neither an intraocular FB nor an intraocular tumor. At this time he was seen for the first time by our facility. Besides a vitreopathy and a visual acuity of 0.2, he impressed with a peripheral iris tumor and a perforation channel in the lens. Ultrasound biomicroscopic (UBM) images showed a tumor with increased reflectivity in the center and a sound shadow. Conventional x-ray of the orbita did not show any signs of a FB. Gonioscopy revealed within the iris stroma an incorporated reddish shining FB. Magnetic resonance imaging of the orbita disclosed the FB, and was interpreted as light metal FB. The FB was surgically removed and x-ray spectral analysis identified the FB as copper. The visual acuity increased to 0.8 within the next weeks. There was no pathology in the electroretinogram.
Conclusions: Tumors of the iris can be simulated by intraocular FB. Todays available imaging techniques are limited to very small metallic FB. Because of the often very small dimensions of the FB an interpretation is difficult. Most important for a causal, effective and early diagnosis and treatment is the history of the case.
Department of Ophthalmology, Otto von Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany