![]() ![]() One month after surgery, she had significant improvement in visual acuity (20/150 right eye, 20/250 left eye), Goldmann visual field testing, and mfERG. Four days after surgery, cobalt serum levels had significantly decreased to 378 ng/mL. She underwent a total hip revision arthroplasty with extensive debridement of “black sludge” found within a pseudocapsule. Goldmann visual field testing demonstrated bilateral central scotomas, optical coherence tomography (OCT) showed severe ganglion cell layer-inner plexiform layer (GCLIPL) thinning and multifocal electroretinography (mfERG) demonstrated decreased amplitudes in both eyes. There was bilateral temporal optic disc pallor. ![]() Visual acuity was 20/600 in the right and 20/800 in the left eye. The possibility of the patient's symptoms being due to cobalt toxicity from her hip prosthesis was proposed and she was found to have a serum cobalt level >1000 μg/L (normal 0–0.9 ng/mL). A few months after surgery, she began experiencing blurred and “white, spotty” vision in both eyes in addition to hypothyroidism, cardiomyopathy and neuropathy. The year prior, she had failure of the hip implant necessitating revision surgery with placement of a chrome-cobalt head. A 59-year-old female with a history of multiple left hip arthroplasties presented to our clinic with bilateral visual loss. ![]()
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