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Jennifer H. Hung, Anu P. Gupta, Amilia Schrier, Richard Braunstein; Recurrent Unilateral Crystal-like Deposits Of Unknown Etiology In The Anterior Chamber. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1251.
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To describe a case of unilateral recurrent crystal-like deposits in the anterior chamber possibly related to medical treatment for rheumatoid arthritis
A 57-year old female with no prior ocular history presented with acute unilateral crystal-like deposits in the anterior chamber of her left eye. Her medical history included rheumatoid arthritis, osteoporosis, alcohol abuse and iron-deficiency anemia. At initial presentation, the patient was being treated with etanercept. Multiple biopsies of the deposits were performed due to recurrence.
Electron microscopy, x-ray crystallography, electron-diffraction spectroscopy, and elemental analysis revealed the deposits to be multilayered hexagonal bipyramids composed of elements including iron, magnesium, aluminum and silicon. Progressive corneal decompensation and elevated intraocular pressure necessitated the need for pars plana vitrectomy, valve placement, repeat deposit excision, cataract extraction and penetrating keratoplasty. Deposit re-accumulation decreased after the discontinuation of etanercept. Further analysis is pending.
This appears to be the first reported case of crystal-like deposits in the anterior chamber that may occur secondary to anti-tumor necrosis factor medication for rheumatoid arthritis.
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