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Kim JH, Jeong HC, Shin YU, Lee WJ. Hemodialysis-induced positional changes in lamina cribrosa. Sci Rep 2024; 14:15250. [PMID: 38956090 PMCID: PMC11219866 DOI: 10.1038/s41598-024-65700-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
This study is aimed to investigate the effect of hemodialysis (HD) on the lamina cribrosa (LC) of the optic nerve head (ONH) using swept-source optical coherence tomography (SS-OCT) and other ophthalmological parameters in patients with end-stage kidney disease (ESKD). This prospective observational study included 29 patients who underwent HD for ESKD. ONH parameters including neural canal diameter (NCD), peripapillary vertical height (PVH), and anterior LC depth (LCD), were assessed using SS-OCT. Changes in the ONH parameters before and after HD were statistically analysed. Correlations between changes in the LCD and other ocular and systemic measurements were identified using Pearson's correlation analyses. The mean anterior LCD significantly decreased from 441.6 ± 139.8 μm before HD to 413.5 ± 141.7 μm after HD (P = 0.001). Mean NCD and PVH did not show significant changes after HD (P = 0.841 and P = 0.574, respectively). A significant correlation was found between changes in the anterior LCD and the mean ocular perfusion pressure (r = 0.397, P = 0.036). We observed a significant decrease in anterior LCD after HD. Our study suggests that HD can influence the ONH, especially in the LC.
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Affiliation(s)
- Ji Hong Kim
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
- Department of Ophthalmology, Hanyang University Seoul Hospital, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
| | - Hyo Chan Jeong
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
- Department of Ophthalmology, Hanyang University Seoul Hospital, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
| | - Won June Lee
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea.
- Department of Ophthalmology, Hanyang University Seoul Hospital, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea.
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Roskal-Wałek J, Gołębiewska J, Mackiewicz J, Bociek A, Wałek P, Biskup M, Bołtuć-Dziugieł K, Starzyk K, Odrobina D, Wożakowska-Kapłon B, Jaroszyński A. The Impact of a Single Haemodialysis Session on the Retinal Thickness and Optic Nerve Morphology. Diagnostics (Basel) 2024; 14:331. [PMID: 38337847 PMCID: PMC10855457 DOI: 10.3390/diagnostics14030331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The aim of the study was to assess the influence of a single haemodialysis (HD) session on the retinal and optic nerve morphology in end-stage kidney disease (ESKD) patients. METHODS It is a prospective study including only the right eye of 35 chronic kidney disease (CKD) patients subjected to HD. Each patient underwent a full eye examination 30 min before HD (8 a.m.) and 15 min after HD. Optical coherence tomography (OCT) was used to assess the peripapillary retinal nerve fibre layer (pRNFL) thickness, macular nerve fibre layer (mRNFL) thickness, ganglion cell layer with inner plexiform layer thickness (GCL+), GCL++ (mRNFL and GCL+) thickness, total retinal thickness (RT) and total macular volume (TMV). The correlation was tested between such systemic parameters changes as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), body weight, plasma osmolarity and ocular perfusion pressure (OPP) and ultrafiltration volume with total RT and pRNFL thickness changes during HD. RESULTS In the results of a single HD session, we could observe a statistically significant increase in the total RT thickness (pre-HD 270.4 ± 19.94 μm, post-HD 272.14 ± 20.11 μm; p = 0.0014), TMV (pre-HD 7.48 ± 0.53 mm3, post-HD 7.52 ± 0.55 mm3; p = 0.0006), total pRNFL thickness (pre-HD 97.46 ± 15.71 μm, post-HD 100.23 ± 14.7 μm; p = 0.0039), total GCL+ thickness (pre-HD 70.11 ± 9.24 μm, post-HD 70.6 ± 9.7 μm; p = 0.0044), and GCL++ thickness (pre-HD 97.46 ± 12.56 μm, post-HD 97.9 ± 12.94 μm; p = 0.0081). We observed a significant correlation between the change in total RT and DBP change, as well as between body weight change and the change in total pRNFL thickness. There was also a correlation between total pRNFL thickness change and the presence of diabetes mellitus. CONCLUSION Even a single HD session affects the retinal and pRNFL thickness, which should be taken into account when interpreting the OCT results in patients subjected to HD. The impact of changes after a single HD session on selected parameters requires further assessment in subsequent studies, including long-term observation.
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Affiliation(s)
- Joanna Roskal-Wałek
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
| | - Joanna Gołębiewska
- Department of Ophthalmology, Military Institute of Aviation Medicine, 01-755 Warsaw, Poland
- Medical Faculty, Lazarski University, 02-662 Warsaw, Poland
| | - Jerzy Mackiewicz
- Department of Vitreoretinal Surgery, Medical University of Lublin, 20-079 Lublin, Poland
| | - Agnieszka Bociek
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
| | - Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Michał Biskup
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland
| | | | - Katarzyna Starzyk
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Dominik Odrobina
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
- Ophthalmology Clinic Boni Fratres Lodziensis, 93-357 Łódź, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
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Markoulli M, Ahmad S, Arcot J, Arita R, Benitez-Del-Castillo J, Caffery B, Downie LE, Edwards K, Flanagan J, Labetoulle M, Misra SL, Mrugacz M, Singh S, Sheppard J, Vehof J, Versura P, Willcox MDP, Ziemanski J, Wolffsohn JS. TFOS Lifestyle: Impact of nutrition on the ocular surface. Ocul Surf 2023; 29:226-271. [PMID: 37100346 DOI: 10.1016/j.jtos.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023]
Abstract
Nutrients, required by human bodies to perform life-sustaining functions, are obtained from the diet. They are broadly classified into macronutrients (carbohydrates, lipids, and proteins), micronutrients (vitamins and minerals) and water. All nutrients serve as a source of energy, provide structural support to the body and/or regulate the chemical processes of the body. Food and drinks also consist of non-nutrients that may be beneficial (e.g., antioxidants) or harmful (e.g., dyes or preservatives added to processed foods) to the body and the ocular surface. There is also a complex interplay between systemic disorders and an individual's nutritional status. Changes in the gut microbiome may lead to alterations at the ocular surface. Poor nutrition may exacerbate select systemic conditions. Similarly, certain systemic conditions may affect the uptake, processing and distribution of nutrients by the body. These disorders may lead to deficiencies in micro- and macro-nutrients that are important in maintaining ocular surface health. Medications used to treat these conditions may also cause ocular surface changes. The prevalence of nutrition-related chronic diseases is climbing worldwide. This report sought to review the evidence supporting the impact of nutrition on the ocular surface, either directly or as a consequence of the chronic diseases that result. To address a key question, a systematic review investigated the effects of intentional food restriction on ocular surface health; of the 25 included studies, most investigated Ramadan fasting (56%), followed by bariatric surgery (16%), anorexia nervosa (16%), but none were judged to be of high quality, with no randomized-controlled trials.
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Affiliation(s)
- Maria Markoulli
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia.
| | - Sumayya Ahmad
- Icahn School of Medicine of Mt. Sinai, New York, NY, USA
| | - Jayashree Arcot
- Food and Health, School of Chemical Engineering, UNSW Sydney, Australia
| | - Reiko Arita
- Department of Ophthalmology, Itoh Clinic, Saitama, Japan
| | | | | | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Katie Edwards
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Judith Flanagan
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia; Vision CRC, USA
| | - Marc Labetoulle
- Ophthalmology Department, Hospital Bicêtre, APHP, Paris-Saclay University, Le Kremlin-Bicêtre, France; IDMIT (CEA-Paris Saclay-Inserm U1184), Fontenay-aux-Roses, France
| | - Stuti L Misra
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | | | - Sumeer Singh
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - John Sheppard
- Virginia Eye Consultants, Norfolk, VA, USA; Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jelle Vehof
- Departments of Ophthalmology and Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK; Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Piera Versura
- Cornea and Ocular Surface Analysis - Translation Research Laboratory, Ophthalmology Unit, DIMEC Alma Mater Studiorum Università di Bologna, Italy; IRCCS AOU di Bologna Policlinico di Sant'Orsola, Bologna, Italy
| | - Mark D P Willcox
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
| | - Jillian Ziemanski
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James S Wolffsohn
- College of Health & Life Sciences, School of Optometry, Aston University, Birmingham, UK
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Zekavat SM, Jorshery SD, Shweikh Y, Horn K, Rauscher FG, Sekimitsu S, Kayoma S, Ye Y, Raghu V, Zhao H, Ghassemi M, Elze T, Segrè AV, Wiggs JL, Scholz M, Priore LD, Wang JC, Natarajan P, Zebardast N. Insights into human health from phenome- and genome-wide analyses of UK Biobank retinal optical coherence tomography phenotypes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.16.23290063. [PMID: 37292770 PMCID: PMC10246137 DOI: 10.1101/2023.05.16.23290063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The human retina is a complex multi-layered tissue which offers a unique window into systemic health and disease. Optical coherence tomography (OCT) is widely used in eye care and allows the non-invasive, rapid capture of retinal measurements in exquisite detail. We conducted genome- and phenome-wide analyses of retinal layer thicknesses using macular OCT images from 44,823 UK Biobank participants. We performed phenome-wide association analyses, associating retinal thicknesses with 1,866 incident ICD-based conditions (median 10-year follow-up) and 88 quantitative traits and blood biomarkers. We performed genome-wide association analyses, identifying inherited genetic markers which influence the retina, and replicated our associations among 6,313 individuals from the LIFE-Adult Study. And lastly, we performed comparative association of phenome- and genome- wide associations to identify putative causal links between systemic conditions, retinal layer thicknesses, and ocular disease. Independent associations with incident mortality were detected for photoreceptor thinning and ganglion cell complex thinning. Significant phenotypic associations were detected between retinal layer thinning and ocular, neuropsychiatric, cardiometabolic and pulmonary conditions. Genome-wide association of retinal layer thicknesses yielded 259 loci. Consistency between epidemiologic and genetic associations suggested putative causal links between thinning of the retinal nerve fiber layer with glaucoma, photoreceptor segment with AMD, as well as poor cardiometabolic and pulmonary function with PS thinning, among other findings. In conclusion, retinal layer thinning predicts risk of future ocular and systemic disease. Furthermore, systemic cardio-metabolic-pulmonary conditions promote retinal thinning. Retinal imaging biomarkers, integrated into electronic health records, may inform risk prediction and potential therapeutic strategies.
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Affiliation(s)
- Seyedeh Maryam Zekavat
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Saman Doroodgar Jorshery
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Departments of Computer Science/Medicine, University of Toronto, Toronto, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
- Department of Computer Science and Electrical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yusrah Shweikh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Katrin Horn
- Institute for Medical Informatics, Statistics and Epidemiology University of Leipzig, Germany and Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
| | - Franziska G. Rauscher
- Institute for Medical Informatics, Statistics and Epidemiology University of Leipzig, Germany and Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
| | | | - Satoshi Kayoma
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Yixuan Ye
- Computational Biology and Bioinformatics Program, Yale University, New Haven, CT, USA
| | - Vineet Raghu
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hongyu Zhao
- Computational Biology and Bioinformatics Program, Yale University, New Haven, CT, USA
- School of Public Health, Yale University, New Haven, CT, USA
| | - Marzyeh Ghassemi
- Departments of Computer Science/Medicine, University of Toronto, Toronto, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
- Department of Computer Science and Electrical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tobias Elze
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Ayellet V. Segrè
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Janey L. Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology University of Leipzig, Germany and Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
| | - Lucian Del Priore
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Jay C. Wang
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
- Northern California Retina Vitreous Associates, Mountain View, CA
| | - Pradeep Natarajan
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
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Impact of Chronic Kidney Disease on Corneal Neuroimmune Features in Type 2 Diabetes. J Clin Med 2022; 12:jcm12010016. [PMID: 36614815 PMCID: PMC9820846 DOI: 10.3390/jcm12010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/02/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Aim: To determine the impact of chronic kidney disease on corneal nerve measures and dendritic cell counts in type 2 diabetes. Methods: In vivo corneal confocal microscopy images were used to estimate corneal nerve parameters and compared in people with type 2 diabetes with chronic kidney disease (T2DM-CKD) (n = 29) and those with type 2 diabetes without chronic kidney disease (T2DM-no CKD) (n = 29), along with 30 healthy controls. Corneal dendritic cell densities were compared between people with T2DM-CKD and those with T2DM-no CKD. The groups were matched for neuropathy status. Results: There was a significant difference in corneal nerve fiber density (p < 0.01) and corneal nerve fiber length (p = 0.04) between T2DM-CKD and T2DM-no CKD groups. The two diabetes groups had reduced corneal nerve parameters compared to healthy controls (all parameters: p < 0.01). Immature central dendritic cell density was significantly higher in the T2DM-CKD group compared to the T2DM-no CKD group ((7.0 (3.8−12.8) and 3.5 (1.4−13.4) cells/mm2, respectively, p < 0.05). Likewise, central mature dendritic cell density was significantly higher in the T2DM-CKD group compared to the T2DM-no CKD group (0.8 (0.4−2.2) and 0.4 (0.6−1.1) cells/mm2, respectively, p = 0.02). Additionally, total central dendritic cell density was increased in the T2DM-CKD group compared to T2DM-no CKD group (10.4 (4.3−16.1) and 3.9 (2.1−21.0) cells/mm2, respectively, p = 0.03). Conclusion: The study showed that central corneal dendritic cell density is increased in T2DM-CKD compared to T2DM-no CKD, with groups matched for peripheral neuropathy severity. This is accompanied by a loss of central corneal nerve fibers. The findings raise the possibility of additional local factors exacerbating central corneal nerve injury in people with diabetic chronic kidney disease.
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Chow JY, She PF, Pee XK, Wan Muda WN, Catherine Bastion ML. Comparison of peripapillary retinal nerve fiber layer and macular thickness in non-diabetic chronic kidney disease and controls. PLoS One 2022; 17:e0266607. [PMID: 35385541 PMCID: PMC8985942 DOI: 10.1371/journal.pone.0266607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Objective This study aimed to compare the peripapillary retinal nerve fiber layer (pRNFL) thickness and macular thickness (MT) between patients with non-diabetic chronic kidney disease (NDCKD) and controls, as well as between different stages of NDCKD. We also evaluated the correlation between pRNFL thickness and MT with duration of NDCKD. Methods This was a comparative cross-sectional study. Subjects were divided into NDCKD and control groups. Both pRNFL thickness and MT, including center subfield thickness (CST), average MT as well as average ganglion cell-inner plexiform layer (GC-IPL) were measured using spectral-domain optical coherence tomography. One-way ANCOVA test was used to compare the differences in pRNFL and MT between NDCKD and controls, as well as between the different stages of NDCKD. Spearman rank-order correlation coefficients were employed to determine the effects of NDCKD duration on pRNFL thickness and MT. Results A total of 132 subjects were recruited, 66 with NDCKD and 66 controls. There was a statistically significant difference in superior (110.74 ± 23.35 vs 117.36 ± 16.17 μm, p = 0.022), nasal (65.97 ± 12.90 vs 69.35 ± 10.17 μm, p = 0.006), inferior quadrant (117.44 ± 23.98 vs 126.15 ± 14.75 μm, p = 0.006), average pRNFL (90.36 ± 14.93 vs 95.42 ± 9.87 μm, p = 0.005), CST (231.89 ± 26.72 vs 243.30 ± 21.05 μm, p = 0.006), average MT (268.88 ± 20.21 vs 274.92 ± 12.79 μm, p = 0.020) and average GC-IPL (75.48 ± 12.44 vs 81.56 ± 6.48, p = 0.001) values between the NDCKD group and controls. The superior quadrant (p = 0.007), nasal quadrant (p = 0.030), inferior quadrant (p = 0.047), average pRNFL (p = 0.006), average MT (p = 0.001) and average GC-IPL (p = 0.001) differed significantly between different stages of NDCKD. There was no correlation between pRNFL thickness and MT with duration of NDCKD. Conclusion CST, average MT, average GC-IPL thickness, average pRNFL and all quadrants of pRNFL except the temporal quadrant were significantly thinner in NDCKD patients compared to controls. These changes were associated with the severity of CKD, but not its duration.
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Affiliation(s)
- Jun Yong Chow
- Faculty of Medicine, Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Center, Cheras, Kuala Lumpur, Malaysia
- Department of Ophthalmology, Hospital Tengku Ampuan Afzan, Ministry of Health, Kuantan, Pahang, Malaysia
- * E-mail: (MLCB); (JYC)
| | - Poh Fong She
- Faculty of Medicine, Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Center, Cheras, Kuala Lumpur, Malaysia
- Department of Ophthalmology, Hospital Tengku Ampuan Afzan, Ministry of Health, Kuantan, Pahang, Malaysia
| | - Xu Kent Pee
- Department of Ophthalmology, Hospital Umum Sarawak, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Wan Norliza Wan Muda
- Department of Ophthalmology, Hospital Tengku Ampuan Afzan, Ministry of Health, Kuantan, Pahang, Malaysia
| | - Mae-Lynn Catherine Bastion
- Faculty of Medicine, Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Center, Cheras, Kuala Lumpur, Malaysia
- * E-mail: (MLCB); (JYC)
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The effect of hemodialysis on macular thickness. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh211028023s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction/Objective. During hemodialysis (HD) treatment great fluctuations
were recorded in the systemic hemodynamic parameters and in the volume and
composition of ocular fluid. There are only a few studies that analyzed the
effect of HD on retinal and macular thickness with conflicting results.
Objective of this study was to determine macular thickness, marked as
central foveal thickness, average macular thickness and macular volume,
shortly before and after HD. Methods. Prospective study of 30 chronic renal
failure (CRF) patients on HD treatment. Thorough ophthalmologic examinations
were performed including evaluation of best corrected visual acuity,
intraocular pressure and slit-lamp examination of all eye segments. Macular
thickness was determined by optical coherence tomography shortly before and
after HD. The next parameters were evaluated: central foveal thickness,
average macular thickness and macular volume. The correlation between
systemic parameters and macular thickness changes during HD was tested.
Results. There were significant changes in body weight and blood pressure
pre- and post-HD. Results showed macular thickness (central foveal
thickness, average macular thickness and macular volume) decreased, but the
change was not significant. There was no significant correlation between
systemic hemodynamic parameters and macular thickness changes. Conclusion.
Results of this study showed there was no statistically significant changes
in macular thickness CRF patient undergoing HD. Further research on a larger
group of patients and a longer follow-up time are required to confirm these
findings.
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Almaznai A, Alsaud S, Fahmy R. Ocular parameters alterations after hemodialysis in patients with chronic kidney diseases. Saudi J Ophthalmol 2021; 35:9-14. [PMID: 34667926 PMCID: PMC8486027 DOI: 10.4103/1319-4534.325775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To evaluate the effects of hemodialysis (HD) on visual acuity (VA), central corneal thickness (CCT), intraocular pressure (IOP), and macular thickness (MT) in chronic kidney disease (CKD) patients and also to investigate the relationship between the ocular parameters and blood biochemical parameters such as serum albumin, creatinine, sodium, and urea levels. METHODS A prospective cohort study including a total of 24 CKD patients of both genders (above 18 years old) undergoing HD in XXX was conducted. The participants were divided into three sub-groups based on the primary cause of renal failure, group 1: Hypertensive kidney disease, group 2: Diabetic kidney disease, group 3: Other causes. All subjects underwent full ophthalmological examinations including measurement of VA using LogMAR, IOP, CCT, and CMT. Comparisons between different ocular parameters during pre- and post-HD sessions were done using the paired t-test. The relationship between changes in ophthalmologic and blood biochemical parameters was calculated using Pearson correlation coefficient. RESULTS HD did not significantly alter any ocular parameter within and between CKD groups. Spherical equivalent changes were found to be significantly correlated with serum K (r = -0.315; P = 0.038), and IOP results were positively correlated with serum creatinine (r = 0.330; P = 0.029) and negatively correlated with hemoglobin (r = -0.349; P = 0.020). Bodyweight alterations were significantly correlated with CCT (r = -0.03; P = 0.0001). However, no correlation between ocular parameters and duration of HD was detected. CONCLUSION Following a single HD session, ocular parameters did not alter significantly.
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Affiliation(s)
- Abdullah Almaznai
- Department of Ophthalmology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Sarah Alsaud
- Department of Optometry and Vision Sciences, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
| | - Rania Fahmy
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Suryakanth S, Shankar HNR, Heralgi MM, Sagar P, Kavitha V, Mahesha S, Babu NS, Tekade P. A study of effect of hemodialysis on macular thickness in patients with end-stage renal disease. Taiwan J Ophthalmol 2021; 11:367-371. [PMID: 35070665 PMCID: PMC8757532 DOI: 10.4103/tjo.tjo_86_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE: The purpose was to study the effect of hemodialysis (HD) on macular thickness in patients with diabetic retinopathy (DR) and end-stage renal disease. MATERIALS AND METHODS: In this prospective observational study, patients undergoing HD for diabetic nephropathy were recruited. None of the patients received treatment for DR per se during the study duration. Patients underwent ocular examination and optical coherence tomography before HD and were followed up on day 3 and day 30. At each visit, central subfield macular thickness (CSMT) and total macular volume (TMV) were measured and compared with baseline values using analysis of variance and post hoc test (Wilcoxon's matched-pairs signed-rank test). RESULTS: Thirty-one eyes of 19 patients were recruited in the study. The mean CSMT decreased from baseline value of 278.93 ± 45.01 μ to 239.81 ± 40.54 μ at the end of 30 days (P < 0.005). The mean TMV decreased from baseline value of 8.14 ± 0.68 mm3 to 7.80 ± 0.63 mm3 on day 30 (P < 0.005). CONCLUSION: There was a statistically significant reduction in CSMT and TMV after HD at 30 days as compared to baseline values. HD alone results in reduction of macular thickness over short term.
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Affiliation(s)
- Shwetha Suryakanth
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - H N Ravi Shankar
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | | | - Pradeep Sagar
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - V Kavitha
- Pediatric Ophthalmology and Strabismus, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - S Mahesha
- Cataract and Trauma, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - N Suresh Babu
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - Pradeep Tekade
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
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Chen SH, Lu DW, Ku WC, Chuang LH, Ferng SH, Chen YJ, Lu YH, Chai PYC. Changes in Intraocular Pressure During Hemodialysis: A Meta-analysis. J Glaucoma 2021; 30:866-873. [PMID: 33813568 DOI: 10.1097/ijg.0000000000001842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/06/2021] [Indexed: 11/27/2022]
Abstract
PRCIS Acetate dialysate causes elevation of intradialytic intraocular pressure (IOP) and contributed to the rise of IOP in the early years of hemodialysis (HD). Glaucoma, narrow-angle, or impaired aqueous outflow is another moderator causing a rise of intradialytic IOP. PURPOSE Severe IOP elevation during HD has been described in many case reports. However, the results of primary studies are conflicting. This meta-analysis examined the impact of HD on IOP and explored the potential moderators. METHODS Medline, PubMed, Embase, Web of Science, and Cochrane were systematically searched. Before-after studies reporting the change of IOP during HD were included. Intradialytic IOP changes were calculated based on 4 different definitions: highest-baseline, lowest-baseline, max-baseline, and end-baseline IOP difference. Standardized mean difference (SMD) was pooled using the random-effects model. RESULTS Fifty-three studies involving 1903 participants and 2845 eyes were included. Overall data pooling showed no significant rise in intradialytic IOP. However, subgroup analysis showed an intradialytic IOP rise before 1986 (SMD: 0.593; 95% confidence interval: 0.169-1.018; max-baseline IOP difference as representative; most studies using acetate dialysate), no change between 1986 and 2005 (using both acetate and bicarbonate), and a decline after 2005 (SMD: -0.222; 95% confidence interval: -0.382 to -0.063; entirely using bicarbonate). Multivariable meta-regression showed only the type of dialysate, but not publication year or other potential factors, as a significant moderator. Glaucoma was found to be another significant moderator independent of the dialysate effect in bivariate meta-regression. CONCLUSIONS IOP elevation in the early years of HD with the use of acetate dialysate is less of a clinical problem following its substitution with bicarbonate dialysate. However, physicians should still be cautious of potential IOP changes in the HD population with glaucoma.
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Affiliation(s)
- Szu-Han Chen
- Departments of Physical Medicine and Rehabilitation
| | - Da-Wen Lu
- Department of Ophthalmology, Tri-service General Hospital
| | | | | | - Shyang-Hwa Ferng
- Division of Nephrology, Department of Internal Medicine, Cathay General Hospital
| | - Yi-Ju Chen
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle Harrisburg, Pennsylvania, PA
| | - Yi-Hsuan Lu
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan, Province of China
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11
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Kurtul BE, Elbeyli A, Kakac A, Turgut F. Corneal endothelial cell density and microvascular changes of retina and optic disc in autosomal dominant polycystic kidney disease. Indian J Ophthalmol 2021; 69:1735-1740. [PMID: 34146017 PMCID: PMC8374801 DOI: 10.4103/ijo.ijo_3212_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Vascular endothelial dysfunction in autosomal dominant polycystic kidney disease (ADPKD) may affect the retinal vascular parameters due to structural similarities of kidney and retina. We aimed to evaluate the microvascular changes of retina and optic disc and also corneal endothelial cell density in patients with ADPKD. Methods: Forty-six eyes of 23 patients with ADPKD (Group 1), and 46 eyes of 23 sex- and age-matched healthy controls (Group 2) were included in this cross-sectional study. Demographic and ophthalmic findings of participants were collected. Corneal endothelial cell density (CECD) measurements were obtained by noncontact specular microscopy. Foveal retinal thickness, peripapillary retinal nerve fiber layer (RNFL) thickness, vessel density in different sections of the retina and optic nerve head were analyzed by optical coherence tomography angiography. Results: The mean ages were 41 ± 11 years for Group 1 and 39 ± 10 years for Group 2 (P = 0.313). CECD values were significantly lower in group 1 when compared to group 2 (2653 ± 306 cells/mm2 and 2864 ± 244 cells/mm2, respectively, P < 0.001). The foveal retinal thickness and RNFL thickness were similar, but superior quadrant thickness of RNFL was significantly lower in Group 1 than Group 2 (126 ± 14 μm vs. 135 ± 15 μm, P = 0.003). In Group 1, whole image of optic disc radial peripapillary capillary densities were significantly lower compared to Group 2 (49.4 ± 2.04%, and 50.0 ± 2.2%, respectively, P = 0.043). There was no significant difference regarding superficial, deep retinal vessel densities, foveal avascular zone and flow areas between the groups (P > 0.05 for all). Conclusion: Lower CECD values and decreased superior quadrant RNFL thickness, and microvascular densities of optic disc were revealed in patients with ADPKD. Evaluation of CECD and retinal microvasculature may be helpful in the management of these patients.
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Affiliation(s)
- Bengi Ece Kurtul
- Department of Ophthalmology, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey
| | - Ahmet Elbeyli
- Department of Ophthalmology, Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey
| | - Ahmet Kakac
- Department of Ophthalmology, Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey
| | - Faruk Turgut
- Department of Nephrology, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey
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Lee WJ, Hong R, Kang MH, Cho H, Han SW, Yi JH, Shin YU, Seong M. Effect of Hemodialysis on Peripapillary Choroidal Thickness Measured by Swept-Source Optical Coherence Tomography. J Glaucoma 2021; 30:459-464. [PMID: 33337722 DOI: 10.1097/ijg.0000000000001762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/13/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim was to investigate the effects of hemodialysis (HD) on peripapillary choroidal thickness (PCT) by swept-source optical coherence tomography and on other ophthalmologic parameters in patients with end-stage kidney disease. MATERIALS AND METHODS This was a prospective observational study. The authors evaluated 29 patients who underwent HD for end-stage kidney disease. Detailed ophthalmologic examinations and swept-source optical coherence tomography were performed immediately before and after HD. PCT was measured using the modification tool in the built-in OCT image viewer program. Changes in PCT before and after HD were statistically analyzed. RESULTS The average PCT significantly decreased from 127.3±49.2 μm before HD to 117.1±50.9 μm after HD (P<0.001). A significant correlation was found between changes in PCT and macular choroidal thickness (ρ=0.547, P=0.002). Changes in mean ocular perfusion pressure did not significantly correlate with changes in PCT (ρ=-0.049, P=0.803). CONCLUSIONS PCT significantly decreased after HD. HD could influence the optic nerve head and its surrounding structures.
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Affiliation(s)
- Won June Lee
- Department of Ophthalmology
- Department of Ophthalmology, Hanyang University Seoul Hospital, Seoul
| | - Rimkyung Hong
- Department of Ophthalmology
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
| | - Min Ho Kang
- Department of Ophthalmology
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
| | - Heeyoon Cho
- Department of Ophthalmology
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
| | - Sang-Woong Han
- Internal Medicine, Division of Nephrology, Hanyang University College of Medicine
| | - Joo-Hark Yi
- Internal Medicine, Division of Nephrology, Hanyang University College of Medicine
| | - Yong Un Shin
- Department of Ophthalmology
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
| | - Mincheol Seong
- Department of Ophthalmology
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
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Kumar K, Balasubramaniam S, Raj P, Agarwal A. Incidence of Paradoxical Neurosensory Detachment in Diabetic Eyes Undergoing Hemodialysis for End-Stage Renal Disease. Cureus 2021; 13:e14739. [PMID: 34079684 PMCID: PMC8162472 DOI: 10.7759/cureus.14739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Ocular fluid dynamics are known to improve during hemodialysis, and the improvement of uremia after dialysis may lead to osmotic pressure changes in the retina, which eventually affect retinal edema. Recent studies using optical coherence tomography (OCT) to assess the effect of hemodialysis on macular thickness have shown variable results with a majority of them finding a decrease in retinal thickness. Paradoxical neurosensory retinal detachment (NSD) may be defined as the accumulation of subretinal fluid under the macula in patients who are on continuous HD. The purpose of the study was to find out the incidence of paradoxical neurosensory detachment in diabetic eyes undergoing hemodialysis (HD) and its management. Methods This was a cross-sectional, prospective study involving end-stage renal disease (ESRD) patients secondary to diabetes. This study evaluated the changes in macular thickness in diabetic retinopathy patients with and without diabetic macular edema (DME) by spectral-domain optical coherence tomography (SD-OCT) 60 minutes before and after HD for ESRD. Results Sixty-three eyes (36 patients) were included, with a mean age of 58.2±9.8 years. Seven eyes had paradoxical NSD at presentation with an incidence of 11.11%. Eyes with DME (Group A) showed a significant reduction in central macular thickness (CMT) by 28±2μm post HD, compared to eyes without DME (Group B) where CMT decreased by 15±2μm (p=0.003). Massive subretinal fluid accumulation (paradoxical NSD) with mean CMT 675.57±69.41μm recovered to 250.71±46.79μm at the final follow-up. Five eyes underwent an intravitreal dexamethasone implant (DEX-I, Ozurdex; Allergan, Dublin, Ireland) to achieve the resolution of SRF, whereas two eyes improved spontaneously by nine months. Conclusion Hemodialysis results in a decrease of macular thickness in diabetic eyes with or without DME. Paradoxical neurosensory detachment can develop in eyes of patients undergoing HD chronically. Intravitreal dexamethasone implant (DEX-I, Ozurdex; Allergan, Dublin, Ireland) results in early amelioration of such a complication.
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Affiliation(s)
| | - Santosh Balasubramaniam
- Vitreo-Retina, Dr. Agarwal's Eye Hospital (Kolkata Branch at Peerless Hospital & B K Roy Research Centre), Kolkata, IND
| | - Pallavi Raj
- Anterior Segment & Glaucoma, Sankar Nethralaya, Kolkata, IND
| | - Amar Agarwal
- Anterior Segment & Cataract, Dr. Agarwal's Eye Hospital (Kolkata Branch at Peerless Hospital & B K Roy Research Centre), Kolkata, IND
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Shoshtari FS, Biranvand S, Rezaei L, Salari N, Aghaei N. The impact of hemodialysis on retinal and choroidal thickness in patients with chronic renal failure. Int Ophthalmol 2021; 41:1763-1771. [PMID: 33740202 DOI: 10.1007/s10792-021-01735-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients with chronic renal failure are commonly cared using a blood filtration mechanism like hemodialysis. Little information is available regarding ocular changes following hemodialysis for people with chronic renal failure. Accordingly, this study intended to estimate the pre- and post-hemodialysis thickness of retina and choroid and other ocular findings in patients with chronic renal failure. METHODS This research is a "before and after" clinical experiment, without control. This prospective study was conducted on patients with chronic renal failure who were in Imam Khomeini Hospital for hemodialysis in 2017. The sample size of this study was estimated to be 67 (134 eyes). In this study, after acquiring consent (by the associated assistant) from all patients, thorough ocular examinations including IOP control, VA and fundus examination, reflection, and macula and choroid OCT were performed 30 min before and after hemodialysis and entered in SPSS V. 16 software by the project manager. Finally, these data were analyzed practicing T-pair tests or their nonparametric equivalent, the Wilcoxon test. RESULTS Based on the results of this examination, studying 67 participating patients, 134 eyes were examined, of which 80 eyes (59.8%) belonged to men, and 54 eyes (40.2%) belonged to women. The mean and standard deviation of participants' age in the study was reported to be 57.3 ± 15 years, and the dialysis duration was 3.0 ± 2.11 h. According to the Wilcoxon test, the average rank in terms of weight, patient temperature, pulse, blood sugar, urea, potassium, ocular pressure, 500-micron nasal choroidal thickness, and myopia in diopter vary significantly before and after dialysis (p < 0.05). However, according to the Wilcoxon test, choroidal thickness in the subfoveal area of the eye (p = 0.600), the retinal thickness in the subfoveal area (p = 0.839), the amount of astigmatism in diopter (p = 0.757) and the amount of hypermetropia in diopter (p = 0.068) before and after dialysis do not have a significant difference. Based on the t test, it was reported that the average creatinine score, the best corrected vision, and the 500 and 1000-micron temporal and nasal choroidal thickness had a significant difference (p < 0.05). CONCLUSION Based on the results of the current study, it was settled that the corrected vision, ocular pressure, as well as the 500-micron nasal choroidal thickness, and myopia in diopter and the 1000-micron temporal and nasal choroidal thickness of patients before and after hemodialysis vary. This difference shows the impact of hemodialysis on changes in ocular characteristics in patients with renal insufficiency.
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Affiliation(s)
- Fariba Shaikhi Shoshtari
- Department of Ophthalmology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sasan Biranvand
- Department of Ophthalmology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leila Rezaei
- Department of Ophthalmology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Nader Salari
- Department of Biostatistics, Faculty of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nasrin Aghaei
- Department of Ophthalmology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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15
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Mayali H, Altinisik M, Sarigul C, Toraman A, Turkoglu MS, Kurt E. Multimodal ocular evaluation in hemodialysis patients. Int Ophthalmol 2021; 41:1799-1805. [PMID: 33683498 DOI: 10.1007/s10792-021-01738-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate choroidal thickness, intraocular pressure (IOP), axial length, central corneal thickness (CCT), lens thickness, anterior chamber depth, and ocular pulse amplitude (OPA) in hemodialysis patients. MATERIALS AND METHODS The patients with end-stage renal disease and undergoing hemodialysis were included in the study. Immediately before and 1 hour after hemodialysis, all patients underwent measurement of choroidal thickness with spectral domain optical coherence tomography (SD-OC, Cirrus HD-OCT; Carl Zeiss Meditec Inc., Dublin, CA), IOP and OPA with Pascal dynamic contour tonometry (Ziemer Ophthalmic Systems AG, Port, Switzerland), and anterior chamber depth, lens thickness, and axial length with optical biometry (LenStar LS900; Haag-Streit AG, Koeniz, Switzerland). Data from the patients' right eyes were included in the statistical analysis. RESULTS The patient group included 8 (36.4%) males and 14 (63.6%) females with a mean age of 56, 14 ± 9, 96 (40-70) years. The mean subfoveal choroidal thickness before and after hemodialysis was 255.21 ± 6.15 (245-263) µm and 234.95 ± 7.89 (220-247) µm, respectively (p < 0.001). Mean choroidal thickness at 1500 µm and 3000 µm nasal and temporal of the fovea also decreased significantly after hemodialysis (p < 0.001). Mean OPA values before and after hemodialysis were 2.14 ± 1.07 (0.6-4) mmHg and 1.6 ± 0.86 (0.5-3.2) mmHg, respectively (p < 0.001). There was a statistically significant correlation between OPA and choroidal thickness measurements (p < 0.001, R = 0.923). IOP increased from 15.11 ± 2.58 (11-20) to 15.99 ± 2.21 (13-20) mmHg, but the change did not reach statistical significance (p = 0.05). There was no statistically significant change in mean axial length, anterior chamber depth, lens thickness, or CCT after hemodialysis (p > 0.05 for all). CONCLUSION Although choroidal thickness and OPA may be decreased immediately after hemodialysis, there may be no significant changes in IOP or avascular ocular structures such as the lens and cornea.
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Affiliation(s)
- Huseyin Mayali
- Ophthalmology Department, Medical School, Manisa Celal Bayar University, Manisa, Turkey.
| | - Muhammed Altinisik
- Ophthalmology Department, Medical School, Manisa Celal Bayar University, Manisa, Turkey
| | - Caglar Sarigul
- Ophthalmology Department, Medical School, Manisa Celal Bayar University, Manisa, Turkey
| | - Aysun Toraman
- Nephrology Department, Medical School, Manisa Celal Bayar University, Manisa, Turkey
| | - Mehmet Sirin Turkoglu
- Ophthalmology Department, Medical School, Manisa Celal Bayar University, Manisa, Turkey
| | - Emin Kurt
- Ophthalmology Department, Medical School, Manisa Celal Bayar University, Manisa, Turkey
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Maharshak I, Hecht I, Mankuta L, Achiron A, Spierer O, Burgansky Z, Bar A, Grossbard A, Katkov A, Cernes R, Feldman L. The effect of hemodialysis on individual retinal layer thickness. Int Ophthalmol 2021; 41:1233-1240. [PMID: 33389423 DOI: 10.1007/s10792-020-01677-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to employ newly developed advanced image analysis software to evaluate changes in retinal layer thickness following hemodialysis. METHODS A non-randomized prospective study of patients with end-stage renal disease assessed on the same day before and after hemodialysis. Intraocular pressure and central corneal thickness were analyzed, and spectral domain optical coherence tomography results were automatically segmented using the Orion software and then compared. All patients had normal retinal optical coherence tomography findings before hemodialysis. RESULTS Of the 31 suitable end-stage renal disease patients treated with hemodialysis who provided consent to participate, seven were unable to complete all evaluations, leaving 24 patients for analysis in the final study group. Their mean age was 66.67±14.3 years (range: 35-88), and 62.5% were males. Mean central corneal thickness did not change following hemodialysis (563.4±30.2 µm to 553.1±47.2 µm, p=.247), while mean intraocular pressure decreased (14.48±2.5 mmHg to 13.16±2.28 mmHg, p=.028). Individual mean retinal layer thickness showed no significant change, including the retinal nerve fiber layer (40.9±6.8 µm to 40.1±5.2 µm, p=.412), the ganglion cell and the inner plexiform layer (68.66±8 µm to 69.03±7.6 µm, p=.639), and the photoreceptor layer (50.26±2.8 µm to 50.32±3.1 µm, p=.869). Total retinal thickness similarly remained constant, with a mean of 303.7±17.3 µm before and 304.33±18.4 µm after hemodialysis (p=.571). CONCLUSIONS Thickness of retinal layers, as assessed by individual segmentation, and central corneal thickness were not affected by hemodialysis treatment, while intraocular pressure was significantly reduced among patients with end-stage renal disease without pre-existing ocular pathology who were undergoing hemodialysis. These results support the view that hemodialysis does not have a negative impact on the retinal morphology of end-stage renal disease patients, who comprise a population with high rates of diabetic and/or hypertensive retinopathy as well as vision-threatening complications.
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Affiliation(s)
- Idit Maharshak
- Department of Ophthalmology, Edith Wolfson Medical Center, 62 Halochamim St, Holon, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center, Beer Yaakov, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lihi Mankuta
- Department of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asaf Achiron
- Department of Ophthalmology, Edith Wolfson Medical Center, 62 Halochamim St, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oriel Spierer
- Department of Ophthalmology, Edith Wolfson Medical Center, 62 Halochamim St, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zvia Burgansky
- Department of Ophthalmology, Meir medical center, Kefar Sava, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Asaf Bar
- Department of Ophthalmology, Edith Wolfson Medical Center, 62 Halochamim St, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aliza Grossbard
- Department of Nephrology and Hypertension, Edith Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anna Katkov
- Department of Nephrology and Hypertension, Edith Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Relu Cernes
- Department of Nephrology and Hypertension, Edith Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Leonid Feldman
- Department of Nephrology and Hypertension, Edith Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Kalayci M, Hassan IA, Keinan IA, Cetinkaya E, Suren E, Tahtabasi M, Sumbul HE. The Effect of Hemodialysis on Axial Length, Ocular Surface, and Intraocular Pressure in Patients with End-Stage Renal Failure. Int J Gen Med 2020; 13:1035-1042. [PMID: 33192087 PMCID: PMC7654548 DOI: 10.2147/ijgm.s281546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the changes in intraocular pressure (IOP), central corneal thickness (CCT), axial length, and ocular surface in patients with end-stage renal failure after single-session hemodialysis treatment and to examine the correlation of these findings with systemic hemodynamic parameters. Patients and Methods A total of 112 eyes of 112 patients enrolled in a hemodialysis treatment program for three times a week (approximately four hours per session) for at least three months in our hospital between December 2019 and March 2020 were included in the study. Approximately 30 minutes before and after hemodialysis, the best-corrected visual acuity measurement, slit-lamp examination, IOP measurement, and dilated fundus examination with the Goldmann applanation tonometer were performed in all patients. The axial length measurement was undertaken by ultrasonic biometry, and the CCT measurement by ultrasonic pachymetry. The ocular surface evaluation was performed based on the tear breakup time (BUT), basal secretion time (BST) and keratoepitheliopathy score. Blood pressure, serum osmolarity, and body weight were measured before and after hemodialysis. Results The mean IOP decreased from 12.2 ± 3.5 to 10.8 ± 2.2 mmHg, and the mean decrease was 1.4 ± 2 mmHg, indicating statistical significance (p<0.001). The mean CCT dropped from 502 ± 41.2 to 494.1 ± 35.4 μm, and the mean decrease was 8.1 ± 7.7 μm, which also indicated a statistically significant change (p<0.001). The mean axial length was reduced from 23.1 ± 0.8 to 22.9 ± 0.8 mm. The reduction in the axial length was significant with an average value of 0.26 ± 0.15 mm (p<0.001). When the ocular surface changes were examined, BUT decreased from 7.4 ± 3.1 to 6.3 ± 2.5 s, BST from 8.6 ± 1.7 to 6.6 ± 1.3 mm, and the keratoepitheliopathy score increased from 0.36 ± 0.61 to 1.59 ± 0.93, and all these changes were statistically significant (p<0.001). There was a significant correlation between the axial length change and the IOP change (r=0.202, p=0.03). A significant correlation was also observed between BST and plasma colloid osmotic pressure (r=−0.268, p=0.004). In addition, there was a strong correlation between serum osmolarity and the keratoepitheliopathy score (r=−0.437, p<0.001). Conclusion Hemodialysis causes significant changes in IOP, CCT, axial length, and ocular surface. These changes should be considered in the ophthalmological examination of patients after the hemodialysis session.
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Affiliation(s)
- Mustafa Kalayci
- Department of Ophthalmology, Somalia Mogadishu-Turkey Education and Research Hospital, Mogadishu, Somalia.,Department of Ophthalmology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ibrahim Ali Hassan
- Department of Ophthalmology, Somalia Mogadishu-Turkey Education and Research Hospital, Mogadishu, Somalia
| | - Ibrahim Abdi Keinan
- Department of Ophthalmology, Somalia Mogadishu-Turkey Education and Research Hospital, Mogadishu, Somalia
| | - Ersan Cetinkaya
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Elcin Suren
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mehmet Tahtabasi
- Department of Radiology, Somalia Mogadishu - Turkey Education and Research Hospital, Mogadishu, Somalia
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, Somalia Mogadishu-Turkey Education and Research Hospital, Mogadishu, Somalia
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Farrah TE, Dhillon B, Keane PA, Webb DJ, Dhaun N. The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons. Kidney Int 2020; 98:323-342. [PMID: 32471642 PMCID: PMC7397518 DOI: 10.1016/j.kint.2020.01.039] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/18/2022]
Abstract
Chronic kidney disease (CKD) is common, with hypertension and diabetes mellitus acting as major risk factors for its development. Cardiovascular disease is the leading cause of death worldwide and the most frequent end point of CKD. There is an urgent need for more precise methods to identify patients at risk of CKD and cardiovascular disease. Alterations in microvascular structure and function contribute to the development of hypertension, diabetes, CKD, and their associated cardiovascular disease. Homology between the eye and the kidney suggests that noninvasive imaging of the retinal vessels can detect these microvascular alterations to improve targeting of at-risk patients. Retinal vessel-derived metrics predict incident hypertension, diabetes, CKD, and cardiovascular disease and add to the current renal and cardiovascular risk stratification tools. The advent of optical coherence tomography (OCT) has transformed retinal imaging by capturing the chorioretinal microcirculation and its dependent tissue with near-histological resolution. In hypertension, diabetes, and CKD, OCT has revealed vessel remodeling and chorioretinal thinning. Clinical and preclinical OCT has linked retinal microvascular pathology to circulating and histological markers of injury in the kidney. The advent of OCT angiography allows contrast-free visualization of intraretinal capillary networks to potentially detect early incipient microvascular disease. Combining OCT's deep imaging with the analytical power of deep learning represents the next frontier in defining what the eye can reveal about the kidney and broader cardiovascular health.
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Affiliation(s)
- Tariq E Farrah
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Baljean Dhillon
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, UK
| | - David J Webb
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Neeraj Dhaun
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Sariyeva Ismayılov A, Aydin Guclu O, Erol HA. Ocular manifestations in hemodialysis patients and short-term changes in ophthalmologic findings. Ther Apher Dial 2020; 25:204-210. [PMID: 32400088 DOI: 10.1111/1744-9987.13510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to investigate the frequency of ocular manifestations in hemodialysis (HD) patients and short-term changes in ophthalmologic findings. A total of 142 eyes of 71 HD patients were included in this study. Patients with corneal and conjunctival deposits, diabetic retinopathy, hypertensive retinopathy, cataract, optic atrophy, or glaucoma were recorded. Schirmer I tests and the tear break up time (TBUT) were performed in the listed order to evaluate dry eye. Axial length (AL) and anterior chamber depth (ACD) were measured using ultrasound biometry using an infrared system. The TBUT test, Schirmer I test, intraocular pressure, AL, and ACD were applied within 30 minutes before and after a single session of HD. The most common ocular findings included conjunctival calcification (60.6%), cataract (50.7%), and proliferative diabetic retinopathy (21.1%). The average TBUT results decreased from 10.81 ± 4.90 to 9.43 ± 4.78 seconds after HD, and was statistically significant (P < .001). The mean Schirmer I test results decreased from 13.59 ± 4.67 to 12.07 ± 4.86 mm after HD. The decline in the Schirmer I test results was statistically significant (P = .005). The mean intraocular pressure decreased from 14.57 ± 4.40 to 13.43 ± 3.91 mm Hg after HD, and was statistically significant (P < .001). The mean ACD increased from 3.19 ± 0.53 to 3.25 ± 0.55 mm, and the mean AL increased from 23.05 ± 1.35 to 23.13 ± 1.35 mm, both increases being significant after HD (both P < .001). Eye diseases such as diabetic retinopathy, corneo-conjunctival calcification, and dry eye are common in HD patients; these patients should undergo early and frequent eye examinations.
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Affiliation(s)
| | - Ozge Aydin Guclu
- Department of Pulmonary Diseases, Boyabat 75th Year State Hospital, Sinop, Turkey
| | - Haşim Atakan Erol
- Department of Internal Medicine, Boyabat 75th Year State Hospital, Sinop, Turkey
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Kösekahya P, Üçgül Atılgan C, Atılgan KG, Koç M, Tekin K, Çağlayan M, Göker YŞ. Corneal Endothelial Morphology and Thickness Changes in Patients with Gout. Turk J Ophthalmol 2019; 49:178-182. [PMID: 31486603 PMCID: PMC6761378 DOI: 10.4274/tjo.galenos.2018.01947] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objectives: To investigate corneal endothelial cell density (ECD), morphology, and central corneal thickness (CCT) in patients with gout compared with healthy subjects. Materials and Methods: Fifty eyes of 50 gout patients and 50 eyes of 50 healthy subjects without gout or any other systemic disease were included in this study. After detailed ophthalmologic examination, specular microscopy (Tomey EM-4000; Tomey Corp) measurement was performed for all participants. ECD, average cell area (ACA), coefficient of variation (CV), hexagonality ratio, and CCT values were recorded. Results: Mean ECD and hexagonality ratio were lower (p=0.004 and p=0.002) and CV, ACA, and CCT values were higher (p=0.001, p=0.007, and p=0.001) in patients with gout when compared to healthy subjects. There were significant correlations between gout disease duration and CD and hexagonality ratio (p=0.019 and p=0.043) and also between uric acid value and hexagonality ratio and CCT (p=0.044 and p=0.003). Conclusion: Altered corneal endothelial function was found in patients with gout when compared to healthy subjects and the alteration increased as gout duration and uric acid value increased.
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Affiliation(s)
- Pınar Kösekahya
- Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
| | | | | | - Mustafa Koç
- Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Kemal Tekin
- Van Erciş State Hospital, Ophthalmology Clinic, Van, Turkey
| | - Mehtap Çağlayan
- Gazi Yaşargil Training and Research Hospital, Ophthalmology Clinic, Diyarbakır, Turkey
| | - Yasin Şakir Göker
- Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
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21
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CHANGES IN OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN PATIENTS WITH CHRONIC RENAL FAILURE UNDERGOING DIALYSIS FOR THE FIRST TIME. Retina 2019; 39:2360-2368. [DOI: 10.1097/iae.0000000000002312] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Sun G, Hao R, Zhang L, Shi X, Hei K, Dong L, Wei F, Jiang A, Li B, Li X, Ke Y. The effect of hemodialysis on ocular changes in patients with the end-stage renal disease. Ren Fail 2019; 41:629-635. [PMID: 31269848 PMCID: PMC6609354 DOI: 10.1080/0886022x.2019.1635494] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Numerous metabolic parameters can be changed during hemodialysis in the end-stage renal disease (ESRD) caused by systemic diseases, such as diabetes mellitus, hypertension. Some ocular parameters also can be variable due to the changes after hemodialysis. This study evaluates the effects of ocular parameters, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), retinal arteriolar caliber (RAC), retinal venular calibre (RVC), in ESRD patients following hemodialysis. Materials and methods: Two-hundred and two ESRD patients were recruited resulting in 404 eyes evaluations. All patients underwent hemodialysis in the Dialysis Unit of the Second Hospital of Tianjin Medical University. BCVA, CMT, IOP, SFCT, RAC and RVC were evaluated before and after hemodialysis. Systemic parameters were collected such as age, body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), duration of hemodialysis, body weight changes, high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC), very low density lipoprotein cholesterol (VLDLC), glycosylated hemoglobin (HbA1c). Results: The causes of ESRD patients included chronic glomerulonephritis (n = 65), diabetes mellitus (n = 60), hypertensive nephrosclerosis (n = 37), and other causes (n = 40). In our study, BCVA (p = .817), CMT (p = .252) and IOP (p = .978) did not significantly change after hemodialysis. SFCT significantly decreased from 254.29 ± 69.36 μm to 235.54 ± 659.90 μm (p = .002) following hemodialysis. SFCT changes were significantly correlated with SBP (p = .042) and body weight changes (p = .044). The RAC and RVC were dilated significantly (p = .033, p = .007). RVC changes were correlated with baseline DBP (p = .003), HDLC (p = .009), LDLC (p = .004) and changes in DBP (p = .037) and body weight (p = .001). Conclusion: Hemodialysis can affect various ocular parameters including SFCT, RAC and RVC, which changed significantly following hemodialysis. Whereas BCVA, IOP and CMT did not change after hemodialysis in ESRD patients. The systemic compensatory mechanisms of the changes in SBP, DBP, body weight following hemodialysis need further study.
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Affiliation(s)
- Guijiang Sun
- Department of Kidney Disease and Blood Purification Treatment, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Rui Hao
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Vision Science, Nankai University Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Longli Zhang
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute, Tianjin, China
| | - Xueying Shi
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute, Tianjin, China
| | - Kaiwen Hei
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute, Tianjin, China
| | - Lijie Dong
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute, Tianjin, China
| | - Fang Wei
- Department of Kidney Disease and Blood Purification Treatment, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Aili Jiang
- Department of Kidney Disease and Blood Purification Treatment, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Bo Li
- Department of Kidney Disease and Blood Purification Treatment, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaorong Li
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute, Tianjin, China
| | - Yifeng Ke
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute, Tianjin, China
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Effect of Hemodialysis on Anterior Chamber Angle Measured by Anterior Segment Optical Coherence Tomography. J Ophthalmol 2019; 2019:2406547. [PMID: 31485341 PMCID: PMC6710785 DOI: 10.1155/2019/2406547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/09/2018] [Accepted: 01/21/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the effect of hemodialysis (HD) on the anterior chamber angle by anterior segment optical coherence tomography (ASOCT) and other ophthalmologic parameters in patients with end-stage kidney disease (ESKD). Methods A prospective observational study was performed on 20 patients who underwent HD for ESKD. Anterior chamber angle images were obtained by 16 mm line scan of ASOCT. The angle opening distance (AOD) and the trabecular-iris space area (TISA) were determined using the ImageJ program. Additional 12 mm horizontal and 9 mm vertical wide-field scans centered on the posterior pole were performed for the measurement of peripapillary retinal nerve fiber layer (pRNFL) thickness and macular ganglion cell-inner plexiform layer (mGCIPL) thickness. Changes in intraocular pressure (IOP), AOD, TISA, pRNFL thickness, and mGCIPL thickness before and after HD were statistically analyzed. Results The IOP decreased significantly from 17.5 ± 3.4 before HD to 16.2 ± 2.3 after HD (P=0.017). There was a statistically significant decrease in AOD 750 and TISA 750 (P=0.005 and P=0.007, respectively). AOD 500 and TISA 500 also decreased, which was almost statistically significant (P=0.061 and P=0.081, respectively). Mean pRNFL thickness and mGCIPL thickness did not show significant change after HD. Conclusion We observed a significant decrease in IOP and anterior chamber angle measurements after HD. Our study suggests that HD can influence the anterior segment structure of eyes.
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Ruiz-Calvo A, Otero-Fernandez CM. [Elevation of intraocular pressure during dialysis after cataract surgery]. J Fr Ophtalmol 2019; 42:e259-e260. [PMID: 31084939 DOI: 10.1016/j.jfo.2018.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 10/26/2022]
Affiliation(s)
- A Ruiz-Calvo
- Service d'ophtalmologie, Hospital Universitario del Sureste, Ronda del Sur, 10, 28500 Arganda del Rey, Madrid, Espagne.
| | - C M Otero-Fernandez
- Service d'ophtalmologie, Hospital Universitario del Sureste, Ronda del Sur, 10, 28500 Arganda del Rey, Madrid, Espagne
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Shin YU, Lee SE, Kang MH, Han SW, Yi JH, Cho H. Evaluation of changes in choroidal thickness and the choroidal vascularity index after hemodialysis in patients with end-stage renal disease by using swept-source optical coherence tomography. Medicine (Baltimore) 2019; 98:e15421. [PMID: 31045801 PMCID: PMC6504263 DOI: 10.1097/md.0000000000015421] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To evaluate the effect of hemodialysis on choroidal thickness and the choroidal vascularity index (CVI) in patients with end-stage renal disease (ESRD) by using swept-source optical coherence tomography.Thirty-two eyes of 32 patients with ESRD undergoing hemodialysis were recruited prospectively. Detailed ophthalmologic examinations and swept-source optical coherence tomography were performed immediately before and after hemodialysis. Choroidal thickness maps were generated automatically by using built-in software. The CVI was calculated using binarized choroidal optical coherence tomography images. Systemic parameters such as body weight and blood pressure were also measured. The changes in systemic and ocular parameters during hemodialysis were evaluated. Subjects were divided into 2 groups (diabetes mellitus [DM] vs non-diabetes mellitus) for subgroup analysis.Total choroidal thickness showed a significant overall decrease after hemodialysis (-10.9 ± 14.0, P <.001). In the subgroup analysis, total choroidal thickness significantly decreased in both patients with DM (-11.3 ± 13.6, P = .004) and those without (-10.6 ± 14.9, P = .020), but the reduction of choroidal thickness was observed in more subfields in patients with DM than in those without. The CVI did not significantly change after hemodialysis (P = .717). No significant systemic and ocular factors affected the changes in total choroidal thicknesses.Choroidal thickness significantly decreased after hemodialysis in most subfields regardless of the presence of DM. Peri-hemodialysis choroidal changes could be considered in the management of patients with ESRD. Swept-source optical coherence tomography can provide ample and reliable quantitative data for monitoring ocular hemodynamic changes.
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Affiliation(s)
| | | | | | - Sang-Woong Han
- Division of Nephrology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Joo-Hark Yi
- Division of Nephrology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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26
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Nusinovici S, Sabanayagam C, Teo BW, Tan GSW, Wong TY. Vision Impairment in CKD Patients: Epidemiology, Mechanisms, Differential Diagnoses, and Prevention. Am J Kidney Dis 2019; 73:846-857. [PMID: 30929852 DOI: 10.1053/j.ajkd.2018.12.047] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/31/2018] [Indexed: 11/11/2022]
Abstract
Eyes and kidneys have numerous structural, developmental, physiologic, and pathogenic pathways in common, suggesting that many kidney and eye diseases may be interlinked. Studies suggest that the prevalence of eye diseases and vision impairment are higher among persons with end-stage kidney disease and earlier stages of chronic kidney disease (CKD) than in those without. Ocular morbidity in persons with CKD and end-stage kidney disease may be due to the following risk factors: (1) underlying conditions and risk factors for CKD such as diabetes or hypertension, (2) metabolic disorders associated with CKD, (3) uremia and anemia, and (4) CKD treatment. Among the chief eye diseases, diabetic retinopathy and age-related macular degeneration are most consistently associated with CKD. Further research for eye diseases such as glaucoma and cataract is needed to determine their relationships with CKD. Despite the high prevalence and burden of vision impairment among persons with CKD, eye screening in patients with CKD is not currently recommended as standard practice. This review suggests that patients with CKD should be encouraged to undergo a complete eye examination. Furthermore, physicians should be aware that patients undergoing dialysis may develop acute eye problems such as acute glaucoma, and appropriate referral to ophthalmologists should be considered in those with a history of glaucoma or recent ocular surgery. Interdisciplinary collaboration between nephrologists and ophthalmologists will ensure enhanced and appropriate management of patients with CKD.
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Affiliation(s)
- Simon Nusinovici
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Boon Wee Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore.
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Kianersi F, Taheri S, Fesharaki S, Fesharaki H, Mirmohammadkhani M, Pourazizi M, Ghalyani M, Moghadam RS. Ocular Manifestations in Hemodialysis Patients: Importance of Ophthalmic Examination in Prevention of Ocular Sequels. Int J Prev Med 2019; 10:20. [PMID: 30820307 PMCID: PMC6390423 DOI: 10.4103/ijpvm.ijpvm_464_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/19/2018] [Indexed: 11/04/2022] Open
Abstract
Background Hemodialysis (HD)-associated ocular abnormalities are one of the causes of morbidity among people undergoing HD. This study evaluates the frequency of ocular abnormalities in end-stage renal disease (ESRD) patients undergoing HD and their potential link to HD and demographic parameters. Methods This cross-sectional study examined 242 eyes of 121 patients with ESRD undergoing regular HD after excluding the ineligible subjects. The study was designed in two parts. Medical histories of each patient including age, gender, family history, medication history, past medical history, and duration of HD collected using a structured check list. All patients underwent complete ophthalmologic examination for evaluation of the best corrected visual acuity (BCVA), intraocular pressure (IOP), and anterior and posterior segments. Results In total, 121 patients, including 68 (56.2%) males and 53 (43.8%) females, were enrolled in the study. The mean ± SD age of the patients and their mean duration of dialysis were 51.59 ± 16.01 and 3.40 ± 2.75 years, respectively. The most prevalent etiology for HD was diabetes mellitus (39.67%), followed by hypertension (38.84%), and the most common ocular findings included cataract (142 eyes; 58.7%) and ectopic calcification of the conjunctiva and cornea (78 eyes; %32.2). There was at least one abnormal ocular finding in 89.3% of the cases. The BCVA was equal to or less than finger count in 70 eyes (28.92%). There was a significant relationship between conjunctival calcification and the duration of dialysis (P = 0.02). There was significant association between etiology of HD and conjunctival calcification (adjusted odds ratio, 2.44; 95% CI, 1.05-5.67; and P value, 0.03). Such significant associations were present for corneal calcification (P = 0.009), cataract (P = 0.02), and optic atrophy (P = 0.01). Conclusions Regular ophthalmologic examinations are recommended due to the prevalence of clinical ocular abnormalities in HD patients.
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Affiliation(s)
- Farzan Kianersi
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan, Iran
| | - Shahram Taheri
- Department of Internal Medicine, Isfahan Kidney Diseases Research Center, Isfahan, Iran
| | - Shahin Fesharaki
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan, Iran
| | - Hamid Fesharaki
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan, Iran
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohsen Pourazizi
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan, Iran
| | - Maryam Ghalyani
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Lim JH, Kim CZ, Lee SUK, Lee SJ. The Effects of Long-term Hemodialysis on Visual Acuity and Central Macular Thickness in Diabetic Retinopathy Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.11.1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jun Hyun Lim
- Department of Ophthalmology, Kosin University College of Medicine, Busan, Korea
| | - Chang Zoo Kim
- Department of Ophthalmology, Kosin University College of Medicine, Busan, Korea
| | - Seung UK Lee
- Department of Ophthalmology, Kosin University College of Medicine, Busan, Korea
| | - Sang Joon Lee
- Department of Ophthalmology, Kosin University College of Medicine, Busan, Korea
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Chen H, Zhang X, Shen X. Ocular changes during hemodialysis in patients with end-stage renal disease. BMC Ophthalmol 2018; 18:208. [PMID: 30139333 PMCID: PMC6107936 DOI: 10.1186/s12886-018-0885-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 08/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background To explore ocular changes during hemodialysis (HD) in chronic renal failure patients and to determine the effects of different causes of renal failure during HD. Methods A total of 90 eyes from 45 end-stage renal disease (ESRD) patients undergoing HD were evaluated in this study. All ophthalmological examinations were conducted within 1 h before and after a single HD session. The HD patients were divided into primary kidney disease (KD), hypertensive KD, diabetic KD (DM-KD) and unknown etiology subgroups according to the primary etiology of renal failure. The statistics of 38 eyes from 19 healthy people were set as normal control. Results Tear break-up time (TBUT) (P = 0.020), Schirmer’s I test results (P = 0.030), anterior chamber depth (ACD) (P = 0.006), lens thickness (LT) (P < 0.001) and choroidal thickness (CHT) (P < 0.001)decreased significantly after a single HD. The retinal nerve fiber layer (RNFL) thickness and average retinal thickness (RT) increased after HD, especially in the nasal inner macula (NIM) subfield (P < 0.001), the inferior inner macula (IIM) subfield (P = 0.004) and the superior outer macula (SOM) subfield (P = 0.012). TBUT, Schirmer’s I test, IOP, RT, and CHT were correlated with one or more parameters. All ESRD patients regardless of etiology had the same trend for most parameters during HD, with the exception of the logMAR of BCVA, central corneal thickness, RNFL thickness and CHT. Conclusions HD may affect a range of ocular parameters in ESRD patients. Dry eye parameters, RT and CHT exhibited the most obvious changes. Different etiologies tended to have similar trends in ocular parameter changes during HD.
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Affiliation(s)
- Hejun Chen
- Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai, 200025, China
| | - Xi Zhang
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.1665 Kongjiang Road, Shanghai, 200092, China
| | - Xi Shen
- Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai, 200025, China.
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Saavedra-Fuentes N, Pérez-Grovas H, Navarrete R, Lerma C. Intraocular Pressure Changes During Hemodialysis or Hemodiafiltration in End-Stage Renal Disease Patients. Ther Apher Dial 2018; 22:624-629. [PMID: 30009462 DOI: 10.1111/1744-9987.12707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the intraocular pressure during hemodialysis and hemodiafiltration. Fifteen patients were enrolled (seven treated with hemodialysis therapy and eight with hemodiafiltration). The intraocular pressure was measured before and after dialysis and every 30 min during dialysis. Before dialysis, both groups had similar dialysis prescription, blood pressure, and biochemical parameters. At the end of dialysis, potassium, and osmolarity decreased in both groups, while systolic blood pressure and sodium decreased in the hemodialysis group, and glucose decreased in the hemodiafiltration group. Mean intraocular pressure was similar between groups at all measured times and had no significant changes during hemodialysis. During minute 120 of hemodiafiltration, mean intraocular pressure in the left eye decreased significantly compared to minute 90. This suggests a high intra-individual variability of intraocular pressure during both types of dialysis, which could be relevant particularly among those with the risk of glaucoma.
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Affiliation(s)
- Nadia Saavedra-Fuentes
- Departamento de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Héctor Pérez-Grovas
- Departamento de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Ruth Navarrete
- Departamento de Glaucoma, Hospital Nuestra Señora de la Luz, Mexico City, Mexico
| | - Claudia Lerma
- Departamento de Instrumentación Electromecánica, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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Effect of Hemodialysis on Eye Coats, Axial Length, and Ocular Perfusion Pressure in Patients with Chronic Renal Failure. J Ophthalmol 2018; 2018:3105138. [PMID: 29576877 PMCID: PMC5822860 DOI: 10.1155/2018/3105138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate changes in eye coats, axial length, and ocular perfusion pressure (OPP) in hemodialysis (HD) patients with chronic renal failure (CRF). Methods We included HD patients who were diagnosed with CRF in our hospital from January to December 2015. Fifty-two patients met the inclusion criteria; all right eyes were used for observation. Systolic and diastolic blood pressures were recorded to calculate OPP. Approximately 30 minutes before and after HD, we recorded multiple parameters, including lens thickness (LT), axial length of vitreous (VAL), axial length of eye (EAL), ciliary body thickness (CBT), choroidal thickness (CT), and retinal thickness (RT). Results After HD, OPP significantly decreased (P < 0.01, F = 7.023) and CBT became significantly thinner (P < 0.01, t = 3.461). CT was significantly thinner and differed among measurement locations (P < 0.01, t = 6.240; P < 0.01, t = 6.169; P < 0.01, t = 3.405, respectively, fovea, nasal, and temporal side 1500 μm beside the fovea). Further, RT thickened and differed among measurement locations (P < 0.05, t = −2.265; P < 0.05, t = −2.624; P < 0.05, t = −2.220, respectively, fovea, nasal, and temporal side 1500 μm beside fovea), whereas LT, VAL, and EAL significantly increased after HD (P < 0.05, t = −2.076; P < 0.01, t = −3.817; P < 0.01, t = −4.010). Conclusions HD impacts the thickness of the eye coats and VAL, particularly affecting CBT, CT, and RT. OPP transiently decreases during HD, which may contribute to an ischemic state.
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Zhang Y, Weng H, Li Q, Wang Z. Changes in retina and choroid after haemodialysis assessed using optical coherence tomography angiography. Clin Exp Optom 2018; 101:674-679. [PMID: 29359351 DOI: 10.1111/cxo.12660] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/03/2017] [Accepted: 12/12/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Reports of choroidal and retinal changes before and after haemodialysis are few and have been controversial. Traditional imaging modalities are insufficient for quantitative assessment. This study aims to use optical coherence tomography angiography to monitor the short-term vascular density and thickness changes in retina and choroid before and after haemodialysis. METHODS Seventy-seven eyes of 77 patients with end-stage kidney disease undergoing haemodialysis were included. Ophthalmologic examinations including optical coherence tomography angiography were performed one hour before and after haemodialysis. The vascular density of retina and choroid were measured and calculated by optical coherence tomography angiography. The retinal thickness and subfoveal choroidal thickness were measured manually using Image J software. The relationships between the changes in ocular and systemic parameters after haemodialysis were evaluated. RESULTS The systolic blood pressure decreased from 123.7 ± 19.7 to 116.9 ± 24.6 mmHg (p < 0.05) in all patients. The mean ocular perfusion pressure decreased significantly after haemodialysis in both diabetic and non-diabetic groups (p < 0.05). Mean retinal thickness decreased from 204.7 ± 22.4 μm to 200.8 ± 22.8 μm (p < 0.05) after haemodialysis in all patients. The vascular density of outer retina was decreased from 38.8 ± 5.5 per cent to 37.5 ± 3.4 per cent (p < 0.05) after haemodialysis in all patients. The changes in diastolic blood pressure, intraocular pressure, subfoveal choroidal thickness, vascular density of the superficial capillary plexus, deep capillary plexus and choriocapillaris were insignificant. There was no significant correlation between systolic blood pressure and the vascular density of the outer retina. CONCLUSION In optical coherence tomography angiography, the retinal thickness became thinner and the vascular density in the outer retina decreased after haemodialysis in patients with end-stage kidney disease. The change of subfoveal choroidal thickness showed no significance after haemodialysis. The decreased volume in the retinal vascular bed and deficient choroidal autoregulatory control of ocular blood flow might be involved in the mechanism of these changes.
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Affiliation(s)
- Yu Zhang
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China
| | - Huan Weng
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qingjian Li
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiliang Wang
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China
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Stamenković D, Vukša D, Đokić O, Mirković J, Mirković M, Jakšić V. Dry eye disease incidence in hemodialysis. PRAXIS MEDICA 2018. [DOI: 10.5937/pramed1804017s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Atilgan CU, Guven D, Akarsu OP, Sakaci T, Sendul SY, Baydar Y, Atilgan KG, Turker IC. Effects of hemodialysis on macular and retinal nerve fiber layer thicknesses in non-diabetic patients with end stage renal failure. Saudi Med J 2017; 37:641-7. [PMID: 27279510 PMCID: PMC4931645 DOI: 10.15537/smj.2016.6.13928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the thicknesses of retinal nerve fiber layer (RNFL) and macula by fourier-domain (FD) optical coherence tomography (OCT) in non-diabetic patients with end-stage-renal-failure (ESRF) undergoing hemodialysis (HD). METHODS This is a prospective and observational study. Both eyes of 20 patients receiving HD (group 1) and 34 control patients (group 2) were evaluated by FD-OCT. Macular and RNFL thicknesses were compared between groups and their correlation with age, duration of HD, and gender were examined. In group 1, macular and RNFL thicknesses were evaluated before and shortly after HD in the first day, first and sixth months. RESULTS In group 1, pre-HD temporal, inferior, average RNFL thicknesses were thinner than group 2. This thinning did not correlate with duration of HD, age and gender. Pre-HD macular thicknesses were thinner than group 2. These thinnings did not correlate with age, but the thinnings at superior, nasal and average thickness correlated negatively with duration of HD. Nasal, temporal, and average macular thicknesses were thinner in female patients. The thickenings of RNFL and macula that were observed in the after HD first day and first month did not showed consistency in the sixth month except superior quadrant RNFL. CONCLUSION Macular and RNFL thicknesses of patients receiving HD were less than the normal population. Age has no effect on these thinnings. The duration of HD affects more than gender. Hemodialysis session causes a consistent increase in superior quadrant RNFL.
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Affiliation(s)
- Cemile U Atilgan
- Department of Ophthalmology, Ulucanlar Eye Teaching and Research Hospital, Altindag, Ankara, Turkey. E-mail.
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Evaluation of the acute effect of haemodialysis on retina and optic nerve with optical coherence tomography. Saudi J Ophthalmol 2016; 30:233-235. [PMID: 28003781 PMCID: PMC5161809 DOI: 10.1016/j.sjopt.2016.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/31/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose The primary objective of haemodialysis (HD) was to correct the composition and volume of body fluids. The aim of this study was to evaluate the acute effect of HD on mean arterial pressure changes and on retina and optic nerve with optical coherence tomography (OCT). Methods Fifty-three eyes of 28 patients were enrolled in this study. The patients’ retinal and RNFL thicknesses were measured by OCT and mean arterial pressure alterations were recorded before and immediately after HD session. Results The results show that while there was a reduction at central foveal thickness and ganglion cell layer thickness, central subfield and RNFL thickness were increased with HD session. But none of them were statistically significant (p = 0.320, p = 0.792, p = 0.744, p = 0.390). The mean arterial pressure of the patients decreased significantly (p < 0.05) but it was not correlated with retinal and RNFL values. Conclusion The changes in retinal and RNFL findings were not significant. But these alterations may effect the long term follow-up of the patients with retinal and optic nerve disease. Therefore it is important to pay attention HD session time for these patients’ measurements.
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Evaluation of Intraocular Pressure by Ocular Response Analyzer in Patients Undergoing Hemodialysis. J Glaucoma 2016; 25:e355-8. [PMID: 26734835 DOI: 10.1097/ijg.0000000000000364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study was to compare the biomechanical parameters of the cornea and intraocular pressure (IOP) before and after hemodialysis (HD) in patients with end-stage renal disease (ESRD) and also healthy subjects. MATERIALS AND METHODS Twenty-one patients with ESRD undergoing HD treatment (study group) and 21 healthy individuals (control group) were enrolled in this prospective study. Right eyes of each subjects were included. Central corneal thickness (CCT) were measured using Sirius Scheimpflug camera. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated IOP (IOPcc), and Goldmann-related IOP (IOPg) were measured using ocular response analyzer. In the study group, measurements were taken just before HD and 30 minutes after HD. RESULTS The mean CCT, CRF, IOPg values did not differ between pre-HD, post-HD, and controls (P > 0.05). CH was found to be significantly higher in control group (10.6 ± 1.2 mm Hg) when compared with pre-HD (8.07 ± 1.8 mm Hg) and post-HD (8.8 ± 1.6 mm Hg) CH values (P = 0.0001). The mean IOPcc values did not differ pre-HD (18.5 ± 3.5 mm Hg) and post-HD (17.8 ± 3.9 mm Hg) (P = 0.39). The mean IOPcc values were lower significantly in control group (15.4 ± 2.8 mm Hg) when compared with pre-HD and post-HD values (P = 0.02 and 0.02, respectively). Significant correlations were seen between post-HD CRF and post-HD CCT (r = 0.6, P = 0.03); and post-HD IOPg and post-HD CCT (r = 0.51, P = 0.01). CONCLUSIONS ESRD may disrupt the biomechanical properties of the cornea. Changes in ocular response analyzer parameters should be kept in mind to evaluate accurate IOP measurements in patients with ESRD.
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Çalışkan S, Çelikay O, Biçer T, Aylı MD, Gürdal C. Effect of hemodialysis on intraocular lens power calculation. Ren Fail 2015; 38:209-13. [DOI: 10.3109/0886022x.2015.1128235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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The Effects of Hemodialysis on Tear Osmolarity. J Ophthalmol 2015; 2015:170361. [PMID: 26640702 PMCID: PMC4657405 DOI: 10.1155/2015/170361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 10/21/2015] [Accepted: 10/26/2015] [Indexed: 11/17/2022] Open
Abstract
Aim. To determine the effects of hemodialysis (HD) on tear osmolarity and to define the blood biochemical tests correlating with tear osmolarity among patients with end stage renal disease (ESRD). Material-Method. Tear osmolarity of ESRD patients before and after the hemodialysis program was determined as well as the blood biochemical data including glucose, sodium, potassium, calcium, urea, and creatinine levels. Results. Totally 43 eyes of 43 patients (20 females and 23 males) with a mean age of 53.98 ± 18.06 years were included in the study. Tear osmolarity of patients was statistically significantly decreased after hemodialysis (314.06 ± 17.77 versus 301.88 ± 15.22 mOsm/L, p = 0.0001). In correlation analysis, pre-HD tear osmolarity was negatively correlated with pre-HD blood creatinine level (r = −0.366, p = 0.016). Post-HD tear osmolarity was statistically significantly correlated with the post-HD glucose levels (r = 0.305 p = 0.047). Tear osmolarity alteration by HD was negatively correlated with creatinine alteration, body weight alteration, and ultrafiltration (r = −0.426, p = 0.004; r = −0.365, p = 0.016; and r = −0.320, p = 0.036, resp.). There was no correlation between tear osmolarity and Kt/V and URR values. Conclusion. HD effectively decreases tear osmolarity to normal values and corrects the volume and composition of the ocular fluid transiently. Tear osmolarity alteration induced by HD is correlated with body weight changes, creatinine alterations, and ultrafiltration.
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The Acute Effect of Hemodialysis on Choroidal Thickness. J Ophthalmol 2015; 2015:528681. [PMID: 26605079 PMCID: PMC4641963 DOI: 10.1155/2015/528681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/21/2015] [Accepted: 10/04/2015] [Indexed: 12/19/2022] Open
Abstract
Objective. To determine the effect of hemodialysis (HD) on choroidal thickness (CT). Methods. The right eyes of 41 patients with end-stage renal disease (ESRD) undergoing HD were included. All patients underwent an ophthalmic examination, including CT measurement via optical coherence tomography, intraocular pressure (IOP), blood pressure, and body weight measurement immediately before and after a HD session. Results. Mean subfoveal choroidal thickness (SFCT) after HD decreased significantly from 254.59 ± 84.66 µm to 229.34 ± 77.79 µm (p < 0.001). CT at the temporal and nasal regions also decreased significantly after HD (both p < 0.001). IOP changes after HD were insignificant (p = 0.958). CT difference was insignificant in patients with diabetes mellitus (DM) and without DM before and after HD, respectively (p = 0.285 and p = 0.707). Stepwise multivariate linear regression analysis showed that diastolic blood pressure was the best fitted factor to explain the changes in CT (r = 0.327 and p = 0.040). Conclusion. CT was decreased in the patients with ESRD following a HD session. This study suggested that the changes in CT may be related to the changes in systemic blood pressure.
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Abstract
The effect of hemodialysis (HD) on intraocular pressure (IOP) is variable and the exact mechanisms are not clear. Increased, decreased, as well as unchanged IOP has been described during HD in various case reports and studies. Patients with certain types of glaucoma and aqueous outflow obstruction of any other cause might be more susceptible to increase in IOP. This can cause severe eye pain, blurry vision, and headaches, causing significant morbidity for such dialysis patients. Certain changes in dialysis prescription may help relieve the above symptoms. There is a lack of awareness among nephrologists about the effects of HD on IOP. This may be especially relevant in the African American patients who besides having a higher risk of developing end-stage renal disease also have a higher risk of developing glaucoma. Recognition as well as management of signs and symptoms of elevated IOP in the dialysis population is significant morbidity and unnecessary work-up.
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Affiliation(s)
- Nidhi Jindal
- Division of Nephrology, Department of Medicine, University of Missouri, Columbia, Missouri, USA
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Twenty-four-hour intraocular pressure monitoring in normotensive patients undergoing chronic hemodialysis. Eur J Ophthalmol 2015; 26:24-9. [PMID: 26165324 DOI: 10.5301/ejo.5000651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate 24-hour intraocular pressure (IOP) changes caused by hemodialysis (HD). METHODS A prospective, observational, comparative 24-hour trial was performed on consecutive subjects with normal IOP undergoing maintenance HD 3 days a week between 13:00 and 17:00 hours in an academic setting. Following a comprehensive ocular assessment, those with conditions that may influence IOP were excluded and one eye was randomly selected. Twenty-four-hour IOP monitoring was performed on HD day 1 and then on a day without HD. The IOP was measured at 10:00, 13:00, 15:00, 17:00, 22:00, 02:00, and 06:00 employing Goldmann and Perkins tonometry on habitual position. During the course of 1 year, 18 patients completed the study. RESULTS Monitoring of IOP on HD day showed a significantly higher mean 24-hour IOP (15.4 ± 2.7 vs 14.1 ± 2.2 mm Hg; p = 0.025), higher mean peak 24-hour IOP (18.5 ± 3.5 vs 15.8 ± 2.5 mm Hg; p = 0.003), and wider 24-hour IOP fluctuation (6.2 ± 2.3 vs 4.0 ± 1.9 mm Hg; p = 0.001). When individual time points were compared, IOP was significantly higher at 17:00 on HD day, reflecting a gradual IOP elevation during HD (p = 0.021). Further, during the HD procedure (13:00-17:00), the mean IOP was significantly higher on a HD day (16.4 ± 3.0 vs 14.7 ± 2.4 mm Hg; p = 0.004). CONCLUSIONS This prospective, before/after trial suggests that HD significantly impacts 24-hour IOP characteristics in normotensive eyes. The long-term significance of these findings requires further elucidation in normotensive patients and, predominantly, in patients with glaucoma undergoing HD.
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Kang NH, Lee S, Jun RM. Comparison of epitheliotrophic factors in autologous serum eyedrops from sera of chronic renal failure patients vs. normal controls. Graefes Arch Clin Exp Ophthalmol 2015; 253:1705-12. [DOI: 10.1007/s00417-015-3056-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/08/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022] Open
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Chelala E, Dirani A, Fadlallah A, Slim E, Abdelmassih Y, Fakhoury H, Baz P, Bejjani R. Effect of hemodialysis on visual acuity, intraocular pressure, and macular thickness in patients with chronic kidney disease. Clin Ophthalmol 2015; 9:109-14. [PMID: 25657575 PMCID: PMC4295916 DOI: 10.2147/opth.s74481] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effects of hemodialysis (HD) on visual acuity, intraocular pressure (IOP), and central foveal thickness (CFT) in patients with chronic kidney disease. MATERIALS AND METHODS Forty-nine eyes from 49 chronic kidney-disease patients were analyzed. Causes of chronic kidney disease included diabetes mellitus (n=9 patients), hypertensive nephrosclerosis (n=15 patients), and other causes (n=25 patients). All patients underwent HD in the Dialysis Unit of Hôtel-Dieu de France Hospital. Best-corrected visual acuity, CFT, and IOP were evaluated before and after HD. CFT was measured with spectral domain optical coherence tomography, and IOP was measured with Goldmann applanation tonometry. RESULTS Neither decimal best-corrected visual acuity (pre-HD 0.71±0.32, post-HD 0.72±0.31; P=0.877) nor CFT (pre-HD 251.39±39.29, post-HD 253.09±39.26; P=0.272) significantly changed after HD. However, mean IOP significantly decreased from 13.99±2.48 before HD to 12.65±2.41 mmHg after HD (P=0.001). IOP change was significantly correlated with serum albumin levels (P=0.008) and weight changes (P=0.047). CONCLUSION HD can affect various ocular parameters. This is particularly true of IOP, which decreases significantly following HD.
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Affiliation(s)
- Elias Chelala
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hôtel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Ali Dirani
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hôtel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Ali Fadlallah
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hôtel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Elise Slim
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hôtel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Youssef Abdelmassih
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hôtel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
| | | | - Patrick Baz
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hôtel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Riad Bejjani
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hôtel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
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Jung JW, Chin HS, Lee DH, Yoon MH, Kim NR. Changes in subfoveal choroidal thickness and choroidal extravascular density by spectral domain optical coherence tomography after haemodialysis: a pilot study. Br J Ophthalmol 2013; 98:207-12. [DOI: 10.1136/bjophthalmol-2013-303645] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lim SH, Son J, Cha SC. Recurrent symptomatic intraocular pressure spikes during hemodialysis in a patient with unilateral anterior uveitis. BMC Ophthalmol 2013; 13:3. [PMID: 23384186 PMCID: PMC3577671 DOI: 10.1186/1471-2415-13-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 01/30/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The relationship between intraocular pressure (IOP) changes and hemodialysis has been evaluated for several decades. However, no report on an IOP rise in uveitis patients during hemodialysis has been previously documented. This report describes the case of an uveitis patient with repetitive IOP spikes associated with severe ocular pain during hemodialysis sessions, which resolved after glaucoma filtering surgery. CASE PRESENTATION A 47-year-old male with diabetes and hypertension had complained of recurrent ocular pain in the left eye during hemodialysis sessions. A slit-lamp examination showed diffuse corneal epithelial edema with several white keratic precipitates and inflammatory cells (Grade 3+) in the anterior chamber of the left eye. No visible neovascularization or synechiae were visible on the iris or angle. Topical glaucoma eye-drops and intravenous mannitol before hemodialysis did not prevent subsequent painful IOP spikes in the left eye. At the end of hemodialysis, IOP averaged ~40 mmHg. After trabeculectomy with mitomycin C in the left eye, his IOP stabilized in the low-teens (range, 10-14 mmHg) and no painful IOP spikes occurred during hemodialysis over the first postoperative year. CONCLUSION We present a case of recurrent painful IOP spikes during hemodialysis in a patient with unilateral anterior uveitis unresponsive to conventional medical treatment prior to hemodialysis. To our knowledge, this is the first case report of repetitive symptomatic IOP rise during hemodialysis in an uveitic glaucoma patient. This case highlights the importance of the awareness of the possibility that IOP may rise intolerably during hemodialysis in uveitis patients with a compromised outflow facility.
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Affiliation(s)
- Su-Ho Lim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Republic of Korea
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