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Kislikova M, Gaitán-Valdizán JJ, Parra Blanco JA, García Unzueta MT, Rodríguez Vidriales M, Escagedo Cagigas C, Piñera Haces VC, Valentín Muñoz MDLO, Benito Hernández A, Ruiz San Millan JC, Rodrigo Calabia E. Looking into the Eyes to See the Heart of Chronic Kidney Disease Patients. Life (Basel) 2024; 14:533. [PMID: 38672803 PMCID: PMC11051204 DOI: 10.3390/life14040533] [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: 03/01/2024] [Revised: 04/03/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
In patients with chronic kidney disease (CKD), the main cause of morbidity and mortality is cardiovascular disease (CVD). Both coronary artery calcium scoring by computed tomography (CT) and optical coherence tomography (OCT) are used to identify patients at increased risk for ischemic heart disease, thereby indicating a higher cardiovascular risk profile. Our study aimed to investigate the utility of these techniques in the CKD population. In patients with CKD, OCT was used to measure the choroidal thickness (CHT) and the thickness of the peripapillary retinal nerve fiber layer (pRNFL). A total of 127 patients were included, including 70 men (55%) with an estimated glomerular filtration rate (eGFR) of 39 ± 30 mL/min/1.73 m2. Lower pRNFL thickness was found to be related to high-sensitivity troponin I (r = -0.362, p < 0.001) and total coronary calcification (r = -0.194, p = 0.032). In a multivariate analysis, pRNFL measurements remained associated with age (β = -0.189; -0.739--0.027; p = 0.035) and high-sensitivity troponin I (β = -0.301; -0.259--0.071; p < 0.001). Severe coronary calcification (Agatston score ≥ 400 HU) was related to a worse eGFR (p = 0.008), a higher grade of CKD (p = 0.036), and a thinner pRNFL (p = 0.011). The ROC curve confirmed that the pRNFL measurement could determine the patients with an Agatston score of ≥400 HU (AUC 0.638; 95% CI 0.525-0.750; p = 0.015). Our study concludes that measurement of pRNFL thickness using OCT is related to the markers associated with ischemic heart disease, such as coronary calcification and high-sensitivity troponin I, in the CKD population.
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Affiliation(s)
- Maria Kislikova
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
| | | | | | | | - María Rodríguez Vidriales
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
| | - Clara Escagedo Cagigas
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
| | - Vicente Celestino Piñera Haces
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
| | - María de la Oliva Valentín Muñoz
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
| | - Adalberto Benito Hernández
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
| | - Juan Carlos Ruiz San Millan
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
| | - Emilio Rodrigo Calabia
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
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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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Dedina L, Hassall MM, Jesudason S, Simon S. Pallid Disc Oedema in a Young Patient: Clinical and Diagnostic Challenge. Neuroophthalmology 2021; 46:95-98. [DOI: 10.1080/01658107.2020.1867873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Liana Dedina
- Ophthalmology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Ophthalmology Unit, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Mark M. Hassall
- Ophthalmology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Ophthalmology Unit, The Queen Elizabeth Hospital, Woodville South, Australia
| | | | - Sumu Simon
- Ophthalmology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Ophthalmology Unit, The Queen Elizabeth Hospital, Woodville South, Australia
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Ab Gani NH, Ibrahim M, Wan Hitam WH, Masnon NA, Hassan A. Bilateral Optic Atrophy in a Young Patient With Chronic Anaemia Secondary to End-Stage Renal Disease. Cureus 2021; 13:e13969. [PMID: 33884230 PMCID: PMC8054838 DOI: 10.7759/cureus.13969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 12/14/2022] Open
Abstract
End-stage renal disease (ESRD) is associated with a number of serious complications, including increased cardiovascular disease, anaemia and metabolic bone disease. Optic atrophy secondary to chronic anaemia in ESRD is rare. We report a case of bilateral optic atrophy in a young patient with chronic anaemia secondary to ESRD. A 23-year-old lady with ESRD, presented with progressive blurring of vision in her left eye for a period of six months. Visual acuity in the left eye was counting finger and the right eye was 6/6. Left optic nerve functions were significantly reduced. Bilateral anterior segments and intraocular pressure were normal. Funduscopy showed bilateral pale disc with arteriolar attenuation. The infective, autoimmune and demyelinating screening were negative. Serial full blood count indicated low haemoglobin and haematocrit value. The full blood picture revealed normocytic normochromic anaemia. Neuroimaging was normal. The patient was diagnosed as having bilateral optic atrophy secondary to chronic anaemia due to ESRD. Chronic anaemia is a potential cause of optic atrophy in a young patient with chronic disease. Management of anaemia in such cases is crucial to prevent irreversible complications including optic atrophy and blindness.
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Affiliation(s)
- Nor Hasnida Ab Gani
- Department of Ophthalmology, Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia/Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Mohtar Ibrahim
- Department of Ophthalmology, Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia/Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Wan-Hazabbah Wan Hitam
- Department of Ophthalmology, Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia/Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Nurul Ain Masnon
- Department of Ophthalmology, Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia/Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Amirah Hassan
- Department of Ophthalmology, Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia/Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
- Ophthalmology, Hospital Serdang, Kajang, MYS
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Wu I, Sun C, Lee C, Liu C, Wong TY, Chen S, Huang JC, Tseng C, Yeung L. Retinal neurovascular changes in chronic kidney disease. Acta Ophthalmol 2020; 98:e848-e855. [PMID: 32190993 DOI: 10.1111/aos.14395] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 02/20/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To examine retinal neurovascular changes in patients with chronic kidney disease (CKD). METHODS Case-control study. A total of 171 CKD cases and 40 controls were recruited (mean age 62.9 ± 10.3 versus 60.8 ± 9.2, p = 0.257). Retinal neural parameters, including parafoveal retinal thickness (PfRT), macular ganglion cell complex thickness (GCCt), global loss volume (GLV), focal loss volume (FLV) and peripapillary retinal nerve fibre layer thickness (RNFLt), were measured using optical coherence tomography (OCT). Microvascular parameters, including foveal avascular zone size, vessel density over the parafoveal superficial vascular plexus (SVP-VD), parafoveal deep vascular plexus (DVP-VD) and radial peripapillary capillary (RPC-VD), were measured using OCT angiography. RESULTS Chronic kidney disease (CKD) patients showed reduced PfRT, GCCt and RNFLt and increased GLV and FLV compared with the controls (all p < 0.005). Among patients with CKD, estimated glomerular filtration rate was an independent factor associated with PfRT (coefficient 0.19, p = 0.015), GCCt (coefficient 0.10, p = 0.006), GLV (coefficient - 0.08, p = 0.001), FLV (coefficient - 0.02, p = 0.006) and RNFLt (coefficient 0.15, p = 0.002). Parafoveal retinal thickness (PfRT), GCCt, GLV, FLV and RNFLt were correlated with SVP-VD (all p < 0.001) but not with DVP-VD (all p > 0.1). CONCLUSIONS Chronic kidney disease (CKD) patients demonstrated a significant reduction in macular thickness and changes in retinal neural parameters. These changes were associated with the severity of CKD and correlated with the microvascular rarefaction in the parafoveal SVP.
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Affiliation(s)
- I‐Wen Wu
- College of Medicine Chang Gung University Taoyuan Taiwan
- Department of Nephrology Keelung Chang Gung Memorial Hospital Keelung Taiwan
- Community Medicine Research Center Keelung Chang Gung Memorial Hospital Keelung Taiwan
| | - Chi‐Chin Sun
- College of Medicine Chang Gung University Taoyuan Taiwan
- Department of Ophthalmology Keelung Chang Gung Memorial Hospital Keelung Taiwan
- Department of Chinese Medicine Chang Gung University Taoyuan Taiwan
| | - Chin‐Chan Lee
- College of Medicine Chang Gung University Taoyuan Taiwan
- Department of Nephrology Keelung Chang Gung Memorial Hospital Keelung Taiwan
| | - Chun‐Fu Liu
- College of Medicine Chang Gung University Taoyuan Taiwan
- Department of Ophthalmology Keelung Chang Gung Memorial Hospital Keelung Taiwan
- Program in Molecular Medicine National Yang Ming University Taipei Taiwan
| | - Tien Yin Wong
- Singapore Eye Research Institute Singapore National Eye Center Duke‐NUS Medical School National University of Singapore Singapore Singapore
| | - Shin‐Yi Chen
- Department of Ophthalmology Keelung Chang Gung Memorial Hospital Keelung Taiwan
| | | | - Chung‐Hsin Tseng
- Department of Ophthalmology Keelung Chang Gung Memorial Hospital Keelung Taiwan
| | - Ling Yeung
- College of Medicine Chang Gung University Taoyuan Taiwan
- Department of Ophthalmology Keelung Chang Gung Memorial Hospital Keelung Taiwan
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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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Su L, Huang G, Yin S, Hua X, Tang X. A clinical analysis of vitrectomy for severe vitreoretinopathy in patients with chronic renal. BMC Ophthalmol 2018; 18:34. [PMID: 29422012 PMCID: PMC5806368 DOI: 10.1186/s12886-018-0704-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 02/02/2018] [Indexed: 02/01/2023] Open
Abstract
Background The recent advancement in the management of chronic renal failure (CRF) has significantly increased the longevity of the patients, which increase the incidence of severe vitreoretinopathy. The vitrectomy is highly risky in this particular group of patients due to their systemic comorbidity. The timing surgical intervention is usually delayed because of the systemic conditions. This study is to evaluate the safety and effectiveness of 25-guage vitrectomy for severe vitreoretinopathy in the CRF patients. Methods In this retrospective study, 16 eyes of 16 CRF patients with severe vitreoretinopathy were undergone 25-guage vitrectomy in the department of Ophthalmology of the Second Hospital of Tianjin Medical University from February 2015 to April 2017. The visual outcome, complications and perioperative medical management were documented and analyzed. Results The best-corrected visual acuity(BCVA)of fourteen eyes were lower than 20/200 preoperatively. Surgery duration ranged from 28 to 72 min, with a mean of 48.4 ± 13.6 min. During the surgery, 12 eyes were diagnosed with DR, while two them were complicated with tractional retinal detachment and one with branch retinal vein occlusion. Three eyes were diagnosed with branch retinal vein occlusion, and one eye was diagnosed with hypertensive retinopathy. Postoperative BCVA of six eyes ≥20/40, seven eyes ≥20/200, and three eyes < 20/200. BCVA of eight eyes improved more than three lines, three eyes improved two lines, and four eyes improved one line. BCVA decreased from hand movement to light perception in one patient who developed neovascular glaucoma two weeks after surgery. Conclusion In chronic renal failure patients with severe vitreoretinopathy, the well-planned minimally invasive vitrectomy is effective and safe. Additionally, careful management of the perioperative systemic conditions is important to improve the visual acuity and quality of life as well.
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Affiliation(s)
- Long Su
- Department of Ophthalmology, The 2nd Hospital of Tianjin Medical University, Tianjin Institute of orbital Disease, Tianjin, China
| | - Guannan Huang
- Department of Ophthalmology, The 2nd Hospital of Tianjin Medical University, Tianjin Institute of orbital Disease, Tianjin, China
| | - Songtao Yin
- Department of Ophthalmology, The 2nd Hospital of Tianjin Medical University, Tianjin Institute of orbital Disease, Tianjin, China
| | - Xia Hua
- Department of Ophthalmology, The 2nd Hospital of Tianjin Medical University, Tianjin Institute of orbital Disease, Tianjin, China
| | - Xin Tang
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Vision Science Clinical College of Ophthalmology, Tianjin Medical University , No. 4 Gansu Rd, Heping District, Tianjin, 300020, China.
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Lee JM, Hong S, Kim CY, Seong GJ. Uremic Optic Neuropathy in Chronic Renal Failure. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.7.1187] [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)
- Ji Min Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Samin Hong
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Hong Samin Optic Nerve Regeneration and Stem Cell Research Institute, Seoul, Korea
- Hong Samin Yonsei Eye Clinic, Seoul, Korea
| | - Chan Yun Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Gong Je Seong
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Anterior ischemic optic neuropathy in pediatric peritoneal dialysis: risk factors and therapy. Pediatr Nephrol 2014; 29:1249-57. [PMID: 24488506 DOI: 10.1007/s00467-013-2747-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/02/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Sudden blindness caused by anterior ischemic optic neuropathy (AION) is a rare complication for patients undergoing peritoneal dialysis (PD). Prognosis is generally poor, with AION commonly resulting in permanent visual loss. METHODS We first describe four case reports of children with AION during PD treatment. We then review ten additional AION cases reported in the literature and compare these 14 affected patients with a control cohort of 59 non-affected patients in the Vienna PD registry. RESULTS Significant risk factors for AION were identified as median age (4 vs. 27 months; p < 0.001), autosomal recessive polycystic kidney disease (28.6 vs. 3.4%; p = 0.01), anephric status (53.8 vs. 6.8%; p < 0.001) and low to normal blood pressure evidenced by the number of patients having to be treated with antihypertensive medications (14.3 vs. 62.7%; p = 0.01). Severe hypovolemia was reported in 50% of all cases. Outcome was visual loss with optic atrophy in nine patients; five patients had a good visual outcome. The major difference in treatment was a rapid bolus of saline within 12 h after the initial symptoms. CONCLUSIONS Young age, autosomal recessive polycystic kidney disease, anephric status and hypotension are substantial risk factors for AION. Early hospitalization with vascular refilling within a few hours following onset of blindness leads to improved visual outcome.
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The Case | Visual loss and bilateral dilated nonreactive pupils in a uremic patient. Kidney Int 2013; 83:535-6. [DOI: 10.1038/ki.2012.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kwak AY, Kim GA, Choi JB. A Case of Acute Nonarteritic Anterior Ischemic Optic Neuropathy in Patient on Hemodialysis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.12.1960] [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)
- Ae Young Kwak
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Siloam Eye Hospital, Seoul, Korea
| | - Gyu Ah Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Siloam Eye Hospital, Seoul, Korea
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14
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Retinal Manifestations of Renal and Connective Tissue Diseases. Clin Ophthalmol 2012; 52:93-105. [DOI: 10.1097/iio.0b013e31823bbb32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Lee KG, Vaithilingam I. Bilateral optic neuropathy-a rare uraemic manifestation of end-stage renal disease. NDT Plus 2011; 4:455. [PMID: 25984229 PMCID: PMC4421674 DOI: 10.1093/ndtplus/sfr150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Kian-Guan Lee
- Renal Medicine Department, Singapore General Hospital, Singapore, Singapore
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Cleper R, Goldenberg-Cohen N, Kornreich L, Krause I, Davidovits M. Neurologic and ophthalmologic complications of vascular access in a hemodialysis patient. Pediatr Nephrol 2007; 22:1377-82. [PMID: 17487512 DOI: 10.1007/s00467-007-0491-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 03/12/2007] [Accepted: 03/16/2007] [Indexed: 11/26/2022]
Abstract
Patients on long-term hemodialysis undergo multiple interventions, including insertion of central catheters and arteriovenous anastomoses for creation of vascular access. The need for high-flow vessels to maintain hemodialysis efficiency leads to wear on the central veins and consequent stenosis and occlusion. In addition to local signs of impaired venous drainage, abnormal venous flow patterns involving the upper chest, face, and central nervous system might develop. We describe the first pediatric case of devastating intracranial hypertension presenting with visual loss in the eye contralateral to a high-flow vascular access in a patient on long-term hemodialysis. The literature on this rare complication of hemodialysis is reviewed.
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Affiliation(s)
- Roxana Cleper
- Department of Pediatric Nephrology, Schneider Children's Medical Center of Israel, Petah Tiqwa 49202, Israel.
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Manley P, Somerfield J, Simpson I, Barber A, Zwi J. Bilateral uraemic optic neuritis complicating acute nephrocalcinosis. Nephrol Dial Transplant 2006; 21:2957-8. [PMID: 16782990 DOI: 10.1093/ndt/gfl321] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paul Manley
- Department of Nephrology, Auckland City Hospital, Private Bag 92024, Auckland, New Zealand.
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Keynan Y, Yanir Y, Shupak A. Hyperbaric therapy for bilateral visual loss during hemodialysis. Clin Exp Nephrol 2006; 10:82-4. [PMID: 16544183 DOI: 10.1007/s10157-005-0398-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Accepted: 11/16/2005] [Indexed: 11/30/2022]
Abstract
Bilateral vision loss during hemodialysis is a rare but devastating entity, with grim prognosis for sight. The etiologies are diverse but share ischemia as a common mechanism. This is a report of a patient with bilateral sight loss during hemodialysis, with early hyperbaric treatment and return of visual acuity to baseline. Hyperbaric treatment should be considered, where early administration is possible, for bilateral blindness during hemodialysis.
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Affiliation(s)
- Yoav Keynan
- Israel Naval Medical Institute, Israel Defence Forces Medical Corps, Haifa, Israel.
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Kirmizis D, Belechri AM, Trigoudis D, Memmos D. Anterior ischemic optic neuropathy in an extreme dipper dialysis patient. Hemodial Int 2005; 9:143-6. [PMID: 16191062 DOI: 10.1111/j.1492-7535.2005.01128.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Dimitrios Kirmizis
- Department of Nephrology and Department of Ophthalmology, Hippokration General Hospital, Thessaloniki, Greece.
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Korzets A, Marashek I, Schwartz A, Rosenblatt I, Herman M, Ori Y. Ischemic optic neuropathy in dialyzed patients: A previously unrecognized manifestation of calcific uremic arteriolopathy. Am J Kidney Dis 2004; 44:e93-7. [PMID: 15558514 DOI: 10.1053/j.ajkd.2004.08.035] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Two patients with end-stage renal disease and on long-term hemodialysis presented with hypotension and an acute unilateral loss of vision. A diagnosis of anterior ischemic optic neuropathy (AION) was made quickly, but despite high-dose steroid therapy, significant vision was not recovered. Temporal artery biopsy results showed extensive medial calcification. The possibility that hypotension, when coupled with calcific uremic arteriolopathy in arteries supplying the optic nerve head, will lead to AION in dialyzed patients is discussed. A short review of AION in the dialysis population is given.
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Affiliation(s)
- Asher Korzets
- Department of Nephrology, Rabin Medical Center (Campus Golda), Petach Tikva, Israel.
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Lapeyraque AL, Haddad E, André JL, Brémond-Gignac D, Taylor CM, Rianthavorn P, Salusky IB, Loirat C. Sudden blindness caused by anterior ischemic optic neuropathy in 5 children on continuous peritoneal dialysis1 1Published partially (case 3) in abstract form in Arch Ped 7:437, 2000, and in Pediatr Nephrol 16:C4, 2001. Am J Kidney Dis 2003; 42:E3-9. [PMID: 14582071 DOI: 10.1016/j.ajkd.2003.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors report the occurrence of sudden blindness in 5 children (mean age, 32 months; range, 11 to 60) during continuous peritoneal dialysis regimen. All children presented with loss of light perception, visual fixation and ocular pursuit, and bilateral mydriasis unreactive to bright light. Fundoscopic examination found signs of anterior ischemic optic neuropathy with disc swelling, edema, and hemorrhages. Whereas 1 patient was dehydrated, the 4 other patients appeared well and not dehydrated. Nevertheless, blood pressure was below the normal range in all of them. Therefore, hypovolemia is highly suspected to have been the cause of ischemic optic neuropathy in all cases. Treatment consisted of steroids (4 patients), anticoagulation or antiagregation drugs (3 patients), plasma or macromolecules infusions (2 patients), vasodilatators (2 patients), and transient dialysis interruption (1 patient). One child with hepatic cirrhosis died 4 days later of acute liver insufficiency owing to ischemic hepatic necrosis. The other children had only partial improvement of vision during the following months. Because the prognosis of ischemic optic neuropathy is very poor, diagnosis and treatment of chronic hypovolemia in children on continuous peritoneal dialysis is essential to prevent such a devastating complication.
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Affiliation(s)
- Anne-Laure Lapeyraque
- Service de Néphrologie and the Service d'Ophtalmologie, Hopital Robert Debré, Assistance Publique-Hopitaux de Paris, Paris, France
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