A Rare Case of Intraocular Gold Foreign Body Induced Traumatic Corneal Endothelial Decompensation Managed With Descemet Stripping Automated Endothelial Keratoplasty

Purpose: This report presents a rare case of a gold intraocular foreign body (IOFB) that remained in the anterior chamber for 28 years, leading to subsequent traumatic corneal endothelial decompensation and cataract development. The purpose is to describe the successful treatment approach. Methods: A 54-year-old Indian man with a history of accidental injury to the left eye involving a burst gold ball in 1994 was examined in September 2023. Results: The patient presented with painless dimness of vision, redness, and watering of the left eye. Examination revealed a gold-colored IOFB in the anterior chamber that adhered to the iris tissue, without an obvious entry wound in the cornea or iris defect. Slit-lamp examination revealed corneal edema, and specular microscopy revealed significantly reduced endothelial cell density. anterior segment optical coherence tomography, UBM, and computed tomography scan confirmed the presence and position of the metallic IOFB. Treatment involved IOFB removal, phacoemulsification, intraocular lens placement, and Descemet stripping automated endothelial keratoplasty in a single setting. The gold foreign body was an alloy of gold, silver, copper, and zinc, which was nonmagnetic in nature and the copper content was significantly less to cause chalcosis. The patient's visual acuity improved significantly postoperatively. Conclusions: Gold IOFBs are uncommon, but they can persist for extended periods without causing noticeable symptoms owing to the inertness and biocompatibility of gold. However, the foreign body was nonmagnetic in nature, mechanical trauma by the foreign body to the endothelium can lead to delayed corneal decompensation. This case demonstrates the successful treatment procedure. Early detection and appropriate management could have averted DSAEK; however, even in the late stage with combined DSAEK, better results can still be obtained.