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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 1  |  Page : 37-38

Rapid Kayser-Fleischer ring following an embedded intracorneal copper foreign body


Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India

Date of Submission25-Apr-2020
Date of Acceptance14-Jul-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Jigyasa Sahu
A-24 Vrindavan Apartments, Sector-6 Plot-1 Dwarka New Delhi - 110 075
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1151_20

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  Abstract 


Keywords: Chalcosis, intraocular copper foreign body, KF ring


How to cite this article:
Arora R, Sahu J, Jain P, Viswanath S. Rapid Kayser-Fleischer ring following an embedded intracorneal copper foreign body. Indian J Ophthalmol Case Rep 2021;1:37-8

How to cite this URL:
Arora R, Sahu J, Jain P, Viswanath S. Rapid Kayser-Fleischer ring following an embedded intracorneal copper foreign body. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Feb 27];1:37-8. Available from: https://www.ijoreports.in/text.asp?2021/1/1/37/305476



A young male presented with a history of trauma to the right eye with a broken copper wire at his workplace four hours before; his visual acuity was 6/6. On slit-lamp biomicroscopy, a small piece of copper wire was found embedded within the deep stromal layer of the inferonasal cornea at a 5 o'clock location, 3 mm from the limbus [Figure 1]a, [Figure 1]b, [Figure 1]c. A greenish-brown mini ring (3.5 mm in diameter), consisting of deposited homogeneous material on the Descemet's membrane, was seen and confirmed by anterior segment optical coherence tomography (OCT) [Figure 1]d; no other abnormality was detected. A rust-colored, pointed foreign body was removed via the intracameral route using a foreign body forceps [Figure 2]a. Postoperatively, the patient was treated with topical prednisolone acetate 1% and topical moxifloxacin 0.5% (each applied 4 times a day). A scar remained at the site of the foreign body. However, the Kayser Fleischer (KF) ring persisted even at one month follow-up [Figure 2]b. The patient's unaided visual acuity continues to be 6/6.
Figure 1: (a) Inferonasal intrastromal copper foreign body with surrounding KF ring, magnification x12. (b) Magnified image, magnification x20. (c) Slit image showing depth of foreign body, magnification x12. (d) Anterior segment optical coherence tomography image showing refractile foreign body in the deep stroma extending up to the endothelium, and a local adjacent rupture of Descemet's membrane and the endothelium with surrounding hyperreflectivity of the KF ring (white arrow)

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Figure 2: (a) The removed rust-coloured foreign body kept on a filter paper (black arrow). (b) Postoperative image showing scarring and opacity at the site of the foreign body removal and persistence of the ring

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  Discussion Top


The clinical picture arising from an intracorneal cuprous foreign body is diverse, ranging from no reaction to necrotic inflammation, and depends on the copper content. A ring-shaped deposition usually takes place, with chronic diffusion of metal from the retained corneal foreign body resulting in direct chalcosis of the cornea. A KF ring is most commonly seen in Wilson's disease,[1] but can also be seen in chronic active hepatitis,[2] primary biliary cirrhosis,[3] hepatocellular disorders and due to the presence of an intracorneal copper-containing foreign body.[4]

To our knowledge, there are no documented reports of intracorneal chalcosis or a pseudo KF ring within four hours of embedment of an intracorneal foreign body. High levels of copper and non- encapsulation possibly led to rapid development of the pseudo KF ring in our patient. This case highlights the need for an early removal of a deep- seated foreign body to avoid irreversible damage to corneal tissues.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kim HB, Kim JC, Byan YJ. Kayser Fleischer ring in Wilson's disease. J Korean Ophthal Soc 1979;20:129-31.  Back to cited text no. 1
    
2.
Zargar SA, Thapa BR, Sahni A, Mehta S. Kayser-Fleischer like ring in autoimmune chronic active hepatitis. Indian J Gastroenterol 1991;10:101-2.  Back to cited text no. 2
    
3.
Fleming CR, Dickson ER, Hollenhorst RW, Goldstein NP, McCall JT, Baggenstoss AH. Pigmented corneal rings in a patient with primary biliary cirrhosis. Gastroenterology 1975;69:220-5.  Back to cited text no. 3
    
4.
Puranik C, Chaurasia S, Ramappa M, Sangwan V, Balasubramanian D. Corneal chalcosis following blast injury. Br J Ophthalmol 2012;96:762.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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