Anterior Ischemic Optical Neuropathy in Children on Chronic Peritoneal Dialysis: Report of 7 Cases

Abstract

ORIGINAL ARTICLES♦ Background: Anterior ischemic optic neuropathy (AION) is characterized by infarction of the optic nerve head due to hypoperfusion of the posterior ciliary arteries and causes sudden blindness in adults on chronic dialysis, but has rarely been described in children. Unlike adults, children do not have comorbidities related to aging. ♦ Methods: We retrospectively analyzed data of 7 children on nocturnal continuous cycling peritoneal dialysis (CCPD) who developed AION identified within the Italian Registry of Pediatric Chronic Dialysis. We also summarized data from 10 cases reported in the literature. ♦ Results: Our 7 patients suffered from acute onset bilateral blindness. Their mean age was 3.2 years and chronic hypotension had been observed prior the AION in 3 of the 7 children. Low systolic blood pressure (SBP) was associated with higher risk of developing AION according to statistical analysis. None recovered completely. In total, 11 out of 16 experienced a partial recovery and no clear evidence emerged favoring specific treatments.

Anterior Ischemic Optic Neuropathy in a Child Receiving Chronic Hemodialysis

“…AION has been reported as a complication of hypotension secondary to chronic dialysis in adult patients, but it is much less common in children [2]. To our knowledge, only 22 cases of pediatric AION have been reported and all of them were receiving peritoneal dialysis [1,[3][4][5]. We present what we believe to be the first case report of AION in a child receiving chronic intermittent hemodialysis.…”

“…AION results from poor perfusion of the optic nerve and is a rare but serious condition that can occur in patients on chronic dialysis [2]. e optic nerve is supplied by the posterior ciliary arteries which arise from the ophthalmic artery [3]. Compromised blood flow through these arteries may lead to ischemia of the optic nerve [3,5].…”

“…e optic nerve is supplied by the posterior ciliary arteries which arise from the ophthalmic artery [3]. Compromised blood flow through these arteries may lead to ischemia of the optic nerve [3,5]. If adequate blood flow is not promptly restored, permanent vision loss can occur [3,5].…”

“…Compromised blood flow through these arteries may lead to ischemia of the optic nerve [3,5]. If adequate blood flow is not promptly restored, permanent vision loss can occur [3,5]. Many factors can contribute to hypoperfusion of the optic nerve, and the risk factors vary between adults and children [3,5].…”

“…If adequate blood flow is not promptly restored, permanent vision loss can occur [3,5]. Many factors can contribute to hypoperfusion of the optic nerve, and the risk factors vary between adults and children [3,5]. In adults, AION is classified as either arteritic or nonarteritic [6].…”