Ocular manifestations in renal allograft recipients: An Indian perspective

Ocular Symptoms in Kidney, Liver, and Heart Transplant Patients

OBJECTIVES

The purpose of this study was to report the ocular manifestations in kidney, liver, and heart transplant recipients.

MATERIALS AND METHODS

We reviewed the medical records of kidney, liver, and heart transplant recipients who were examined at the ophthalmology clinic of a tertiary hospital between October 2021 and October 2022. We evaluated the ocular complaints of the patients, ophthalmological examination findings, the etiology of the underlying disease, comorbidities, posttransplant duration, and the medications used. Ocular pathologies were classified as corneal, conjunctival, lens, vitreoretinal, and optic disc pathologies for the analysis.

RESULTS

Our study included 233 patients (191 kidney, 40 liver, 2 heart transplant patients). Mean age of patients was 42.94 ± 17.45 years. Among the patient group, 80.3% had at least 1 pathological ocular finding. In subgroup analysis, 12.4% of the patients had corneal pathologies, 19.3% had conjunctival pathologies, 33.0% had lens pathologies, 33.5% had vitreoretinal pathologies, and 18.9% had optic disc-related pathologies. The most common finding was dry eye, followed by cataract and vitreoretinal pathologies. The most common vitreoretinal pathology was diabetic retinopathy, followed by hypertensive retinopathy. The ocular pathology incidence in kidney and liver transplant patients was similar (P = .05). The 2 heart transplant patients did not have any ocular pathologies except refractive errors. In addition, no significant correlation was observed between posttransplant duration and ocular pathologies (P = .28).

CONCLUSIONS

Ocular findings were seen in most of the kidney and liver transplant recipients. Therefore, it is required that these patients undergo routine ocular screenings in order to facilitate early diagnosis and prompt treatment when needed.

Eye Lesions in Patients After One Year of Kidney Transplantation

Purpose

Determine the incidence of some eye lesions in kidney transplant patients after one year at Military Hospital 103 and comment on related factors.

Patients and Methods

A cross-sectional study description of 111 kidney transplant patients (222 eyes) at Military Hospital 103. We assessed several eye lesions, including dry eyes, corneal conjunctival calcification, cataracts, and retinopathy.

Results

The rate of retinopathy was 84.7%, dry eye was 59.5%, cataract was 29.7%, and corneal conjunctival calcification was 24.8%, atrophy optic nerve was 9.9%, epiretinal membrane was 1.8%. Post-transplant influence factors associated with cataracts include the dose of prednisolone (OR= 1.6, p < 0.05) and post-transplant diabetes (OR=1.4, p < 0.05). The influence factor related to the atrophy of the optic nerve is systemic infection after transplantation (OR=2.4, p < 0.05).

Conclusion

Retinopathy accounted for the highest rate, followed by dry eye disease; cataracts ranked third; and finally, calcified corneal conjunctiva. Factors that affect cataracts are diabetes mellitus and prednisolone dose. Factors affecting optic nerve atrophy are infections after kidney transplantation.

Insights From the Eye for Patients With Kidney Transplant

The eye and the kidney share structural and developmental similarities on a cellular and clinical level, and they are often affected by the same disease processes. Performing an eye exam to look for signs of conditions such as hypertension and diabetes can provide a helpful window into the health of the kidney. Patients with kidney transplants (KT) are a unique population that require close monitoring. These patients are maintained on a number of immunosuppressive medications and may face complications such as medication side effects, infections, and graft rejection. Patients with KT are at higher risk of both infectious and noninfectious eye conditions related to underlying systemic disease or use of immunosuppressive medications. Screening for eye conditions is important because preserving visual function is integral to quality of life, and also because the eye exam can help with early detection and treatment of systemic conditions. Here we describe some of the common eye findings and conditions in patients with KT. We recommend that patients with KT receive annual eye exams, and we hope that the information provided here can help nephrologists become more familiar with eye findings and identify situations where a referral to ophthalmology is warranted.

EYE DISEASE IN KIDNEY TRANSPLANTATION: CLINICAL CHALLENGES IN A UNIQUE PATIENT POPULATION

Eye disease is common among kidney transplant recipients and their management is challenging. Chronic kidney disease is associated with ocular complications, both independently and in the context of various systemic disorders. In addition, chronic immunosuppression predisposes kidney transplant recipients to an array of long-term ocular issues. This may be broadly categorized into infections, malignancies, and other immunosuppression-specific side effects. The interdependence of kidney disease, transplant pharmacotherapy and ocular health therefore requires a multispecialty approach. Although the kidney transplant population has grown along with the burden of associated oculopathies, systematic guidelines targeting this patient group are lacking. This evidenced-based narrative review summarizes the pertinent issues that may present in the ophthalmic and optometric clinical settings, with emphasis on collaborative management and directions for future research.