Author Affiliations: South Australian Institute of Ophthalmology and Discipline of Ophthalmology and Visual Sciences, University of Adelaide (Drs Chan and Selva), Adelaide Pathology Partners (Dr James), and the Division of Tissue Pathology, SA Pathology (Drs Sutton-Smith and Dodd), Adelaide, South Australia, Australia.
We read with interest the article by Lockington et al1 on tissue reaction to gold eyelid weights; herein we describe, to the best of our knowledge, the first reported case of symptomatic tissue reaction to a platinum eyelid weight.
An 85-year-old man underwent pretarsal insertion of an upper-eyelid, 1.2-g, platinum-iridium eyelid chain (Spiggle & Theis GmbH, Dieburg, Germany) for exposure keratopathy due to nonresolving Bell palsy. He presented 5 months later with good recovery of orbicularis function but had upper-eyelid pretarsal edema and erythema; there was no significant pain or tenderness. The chain was explanted at 6 months. Intraoperatively, there was fibrosis around the chain and within fixation holes. There were fine black particles seen in tissue adjacent to the chain. The chain appeared well fixated to the tarsus, with no mobility. The pretarsal edema resolved following explantation, and the patient remained free of complications at follow-up 2 months later.
Histology of the peri-implant tissue revealed mild lymphohistiocytic inflammatory response and deposition of black granular material within the fibrous tissue and cytoplasms of histiocytes and foreign body giant cells (Figure 1). Scanning electron microscopic X-ray microanalysis confirmed the black granular material to be platinum particles (Figure 2).
Figure 1. Mild lymphocytic inflammatory infiltrate associated with dense focally diathermied collagen with deposition of black granules, free-lying and in the cytoplasm of histiocytes and a multinucleate giant cell (arrow) (hematoxylin-eosin; original magnification ×400).
Figure 2. Trace from energy dispersive X-ray spectrometry showing peak for platinum (Pt).
Incidental histological finding of foreign body reaction to platinum particles has been described in patients with eyelid weights explanted owing to recovery of function and weight migration.2 It may be that most tissue reactions to platinum particles are subclinical or asymptomatic.
While platinum eyelid weights, compared with gold eyelid weights, have better biocompatibility, higher patient satisfaction, and fewer postoperative complications,1 ,3 - 4 symptomatic tissue reaction necessitating explantation may still occur.
Correspondence: Dr Chan, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia 5000 (onn912@gmail.com).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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