Abstract
Purpose
The effect of elevated serum cobalt on the human visual system has not yet been established. In light of recent reports of visual problems with elevated cobalt in association with hip prostheses, this review examines the literature for evidence regarding the effects of cobalt on human visual function.
Methods
A systematic literature review was undertaken in July 2013. The electronic databases of PubMed (1955 to July week 1 2013), Cochrane Library and EMBASE were searched. Only human studies or case reports written in English were included.
Results
Eight case reports were identified. Five case reports involved patients with metal hip arthroplasties, two cases involved patients exposed to environmental cobalt, and one case involved a patient treated medically for anaemia with cobalt chloride. No human prospective studies were identified.
Conclusions
Several case reports showed that high serum cobalt may be associated with both irreversible and reversible visual loss, optic neuropathy and atrophy, electrophysiological evidence of abnormal retinal and retinal pigment epithelium function and fluorescein angiographic evidence of abnormal choroidal perfusion.
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References
Licht A, Oliver M, Rachmilewitz EA (1972) Optic atrophy following treatment with cobalt chloride in a patient with pancytopenia and hypercellular marrow. Isr J Med Sci 8(1):61–66
Meecham HM, Humphrey P (1991) Industrial exposure to cobalt causing optic atrophy and nerve deafness: a case report. J Neurol Neurosurg Psychiatry 54(4):374–375
Steens W, von Foerster G, Katzer A (2006) Severe cobalt poisoning with loss of sight after ceramic-metal pairing in a hip—a case report. Acta Orthop 77(5):830–832
Rizzetti MC, Liberini P, Zarattini G et al (2009) Loss of sight and sound. Could it be the hip? Lancet 373(9668):1052
Rizzetti MC, Catalani S, Apostoli P, Padovani A (2011) Cobalt toxicity after total hip replacement: a neglected adverse effect? Muscle Nerve 43(1):146–147
Tower SS (2010) Arthroprosthetic cobaltism: neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty: a case report. J Bone Joint Surg Am 92(17):2847–2851. doi:10.2106/JBJS.J.00125
Bhardwaj N, Perez J, Peden M (2011) Optic neuropathy from cobalt toxicity in a patient who ingested cattle magnets. Neuroophthalmology 35(1):24–26
Ng SK, Ebneter A, Gilhotra JS (2013) Hip-implant related chorio-retinal cobalt toxicity. Indian J Ophthalmol 61(1):35–37
Apel W, Stark D, Stark A, O’Hagan S, Ling J (2013) Cobalt-chromium toxic retinopathy case study. Doc Ophthalmol 126(1):69–78. doi:10.1007/s10633-012-9356-8
Apel W, Stark D, O’Hagan S (2013) An update on cobalt-chromium toxic retinopathy. Doc Ophthalmol 127(2):173–175. doi:10.1007/s10633-013-9385-y
Schirrmacher UO (1967) Case of cobalt poisoning. Br Med J 1(5539):544–545
Barceloux DG (1999) Cobalt. J Toxicol Clin Toxicol 37(2):201–206
Kerman HD (1951) Medical uses of cobalt 60. South Med J 45(6):495–503
Holland MA, Kozlowski LM (1986) Clinical features and management of cyanide poisoning. Clin Pharm 5(9):737–741
Hall AH, Saiers J, Baud F (2009) Which cyanide antidote? Crit Rev Toxicol 39(7):541–552
Schmidt M, Weber H, Schon R (1996) Cobalt chromium molybdenum metal combination for modular hip prostheses. Clin Orthop Relat Res 329 Suppl:S35–S47
Jantzen C, Jorgensen HL, Duus BR, Sporring SL, Lauritzen JB (2013) Chromium and cobalt ion concentrations in blood and serum following various types of metal-on-metal hip arthroplasties: a literature overview. Acta Orthop 84(3):229–236. doi:10.3109/17453674.2013.792034
Reito A, Puolakka T, Elo P, Pajamaki J, Eskelinen A (2013) High prevalence of adverse reactions to metal debris in small-headed ASR hips. Clin Orthop Relat Res 471(9):2954–2961. doi:10.1007/s11999-013-3023-6
Marshall RA (1959) A review of lesions in the optic fundus in various diseases of the blood. Blood 14(7):882–891
Gallemore RP, Steinberg RH (1991) Cobalt increases photoreceptor-dependent responses of the chick retinal pigment epithelium. Invest Ophthalmol Vis Sci 32(12):3041–3052
Fahrenfort I, Sjoerdsma T, Ripps H et al (2004) Cobalt ions inhibit negative feedback in the outer retina by blocking hemichannels on horizontal cells. Vis Neurosci 21(4):501–511
Evans JA, Hood DC, Holtzman E (1978) Differential effects of cobalt ions on rod and cone synaptic activity in the isolated frog retina. Vision Res 18(2):145–151
Hara A, Niwa M, Aoki H et al (2006) A new model of retinal photoreceptor cell degeneration induced by a chemical hypoxia-mimicking agent, cobalt chloride. Brain Res 1109(1):192–200
Apostoli P, Catalani S, Zaghini A et al (2013) High doses of cobalt induce optic and auditory neuropathy. Exp Toxicol Pathol 65(6):719–727. doi:10.1016/j.etp.2012.09.006
Brouzas D, Charakidas A, Ladas I, Apostolopoulos M (2009) Nonarteritic anterior ischemic optic neuropathy associated with chronic anemia: a case series of myelodysplastic syndrome patients. Clin Ophthalmol 3:133–137
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Lim, C.A., Khan, J., Chelva, E. et al. The effect of cobalt on the human eye. Doc Ophthalmol 130, 43–48 (2015). https://doi.org/10.1007/s10633-014-9469-3
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DOI: https://doi.org/10.1007/s10633-014-9469-3