Ophthalmological complications of haemodialysis and kidney transplantation

Ocular findings in IgA nephropathy with renal failure and hypertension

A patient with IgA nephropathy developed cotton-wool spots and serous retinal detachments. Fluorescein angiography demonstrated choroidal infarcts in both eyes from hypertensive retinopathy in acute on chronic renal failure. Plasmapheresis and hemodialysis led to visual recovery. Acute ocular hypertensive changes from IgA nephropathy may be reversed by plasmapheresis and hemodialysis.

Fundus fluorescein angiography of patients with severe hypertensive nephropathy

PURPOSE

To analyze the fluorescein angiograms of patients with hypertensive renal failure.

METHODS

Fluorescein angiograms were obtained of 34 patients with hypertensive renal failure. The glomerular filtration was less than 20 ml/min in each patient.

RESULTS

Capillary nonperfusion and a coarse retinal capillary bed are the hallmark of the hypertensive retinopathy. Tortuous retinal arterioles or tortuous retinal arteriovenous anastomoses are observed. It is suggested that capillary collaterals shunt arteriolar obstructions or short-cut nonperfused capillary beds; these remodel into tortuous arterioles or arteriovenous anastomoses with regular caliber. Elschnig spots and delayed choroidal filling are signs of hypertensive choroidopathy. Depigmentation spots of the retinal pigment epithelium without a central pigment clump are considered atypical Elschnig spots.

CONCLUSIONS

Retinal pigment epithelial changes are permanent scars of hypertensive choroidopathy, while coarse retinal capillary bed and tortuous retinal arterioles or arteriovenous anastomoses are the result of hypertensive retinopathy in these patients with hypertensive renal failure.

Diffuse retinal pigment epitheliopathy complicating systemic corticosteroid treatment

AIMS/BACKGROUND

This study was undertaken to confirm the association between diffuse retinal pigment epitheliopathy (DRPE) and systemic corticosteroid therapy. This finding can be of help in determining an aetiological factor in DRPE and associated diseases. Corticosteroids may contribute to the development of leakage in the presence of a retinal pigment epitheliopathy or central serous chorioretinopathy.

METHODS

Cases of DRPE were collected from the files of members of the European Fluorescein Angiography Club. There were 34 who developed their ophthalmic symptoms while being treated with corticosteroids.

RESULTS

DRPE developed in 34 patients from 10 European eye clinics during systemic treatment with corticosteroids. Thirteen patients were treated with corticosteroids after allotransplantation, 21 other patients developed ocular symptoms while treated with steroids for serious systemic disorders. Symptoms occurred in some patients when the daily corticosteroid dosage was elevated, and the visual complaints ameliorated or even disappeared sometimes on discontinuation of the corticosteroid therapy.

CONCLUSION

Corticosteroids can damage the retinal pigment epithelial barrier and predispose a patient to serous retinal detachment, whereas psychological stress may play a role in the development of central serous chorioretinopathy. A decrease of the daily corticosteroid dosage may help to diminish the visual symptoms.

Purtscher's-like retinopathy in chronic renal failure

PURPOSE

The authors describe the clinical findings of three young women with the previously unreported association of Purtscher's-like retinopathy and chronic renal failure.

METHODS

The authors reviewed the clinical records of three women with chronic renal failure who had been seen at the Oregon Health Sciences University with acute, profound visual loss associated with a severe vaso-occlusive Purtscher's-like retinopathy.

RESULTS

Two of the three patients previously had renal transplants, and both were experiencing allograft rejection. One of these two patients was undergoing hemodialysis. The retinopathy was bilateral in two patients, and unilateral in the third. Each of the 5 affected eyes had severe initial loss of vision to less than 20/400, and only one of these eyes had significant visual recovery. None of the patients had recent trauma, pancreatitis, autoimmune disease, or other condition known to be associated with Purtscher's-like retinopathy.

CONCLUSION

A retinal vaso-occlusive disorder resembling Purtscher's retinopathy can occur in patients with chronic renal failure, even in the absence of trauma, pancreatitis, or known autoimmune disease. While the precipitating factor(s) remains unclear, it appears that the retinopathy in this setting may be more severe and associated with a poorer visual prognosis.

Ocular manifestations of Alport's syndrome: a hereditary disorder of basement membranes?

The ocular manifestations in 16 patients with Alport's syndrome were lenticonus and retinal flecks in the macula and mid periphery. These 3 features appear to be specific for this syndrome and are a considerable aid to diagnosis. Lens opacities are common, and other ocular abnormalities occur sporadically. The present evidence indicates that this is a hereditary, widespread disorder of basement membrane, and it is suggested that ophthalmologists may contribute to the further understanding of it by directing attention towards analysis of the lens capsule after cataract extraction. The similarity of the retinopathy to that of fundus albipunctatus is noted, and it is suggested that the latter condition should not be diagnosed in the absence of renal investigation and audiometry.

Ocular complications in haemodialysis and renal transplant patients

115 patients on haemodialysis and 160 renal transplant patients were examined over an eight year period. A high percentage in both groups were found to have ocular complications. These included disorders of the cornea, lens, retina, choroid, and optic nerve. In contrast to other studies on renal transplant patients a relatively large number had symptoms and even required surgery for cataract removal. 65 (40.7%) had posterior sub-capsular cataracts. It is likely that nearly all were caused by the use of prednisone for immunosuppression. Of this number 25 (38.5%) had symptoms and 12 (18.5%) required cataract extraction. Pigmentary disturbances of the retinal pigment epithelium, together with vascular changes in the choroid were found in some. The implication of these relatively unknown complications, together with their possible aetiology, is discussed. The study emphasises the fact that all haemodialysis and renal transplant patients should be monitored for ocular complications.