Management of intraocular pressure elevation during hemodialysis of neovascular glaucoma: a case report

Frezzotti, Paolo; Menicacci, Cristina; Bagaglia, Simone Alex; Mittica, Pietro; Toto, Francesca; Motolese, Ilaria

doi:10.1186/s12886-016-0199-z

Cited by 12 publications

(17 citation statements)

References 20 publications

(29 reference statements)

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“…Hemodialysis (HD) is one of the main treatment methods in patients with CRF; its main objective is to correct the excessive accumulation and abnormal distribution of body fluid. However, sometime during or after HD, patients will occasionally develop a sharp increase in intraocular pressure (IOP), followed by transient blurred vision, eye pain, headache, and other symptoms [ 1 , 2 ]. HD can also cause macular edema, ischemic optic neuropathy, retinal hemorrhage, retinal detachment, and other changes [ 3 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Hemodialysis on Eye Coats, Axial Length, and Ocular Perfusion Pressure in Patients with Chronic Renal Failure

Yin

Chen

et al. 2018

Journal of Ophthalmology

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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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Section: Introductionmentioning

confidence: 99%

Effect of Hemodialysis on Eye Coats, Axial Length, and Ocular Perfusion Pressure in Patients with Chronic Renal Failure

Yin

Chen

et al. 2018

Journal of Ophthalmology

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“…For those individuals susceptible to experiencing IOP elevation during HD, chronic elevation in IOP might result in optic nerve damage. Some approaches have been reported to hinder a symptomatic rise in IOP during dialysis, including intravenous mannitol [ 35 ], hypertonic sodium dialysis or use of hyperosmotic agents [ 12 ], slower urea removal [ 36 ], modified dialysis parameters with colloid infusion [ 30 ], and intravenous glucose administration [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Risk of Glaucoma in Patients Receiving Hemodialysis and Peritoneal Dialysis: A Nationwide Population-Based Cohort Study

Lim

Lee

Huang

et al. 2020

IJERPH

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This paper investigated the incidence and risk of newly diagnosed glaucoma after the initiation of maintenance dialysis in Taiwan. A case–control study was conducted using the National Health Insurance Research Database (NHIRD) in Taiwan. There were 3949 patients with dialysis in the study group and 78,980 non-dialysis subjects matched by age and sex in the comparison group. The incidence of newly diagnosed glaucoma after the initiation of maintenance dialysis was analyzed based on the diagnostic code for glaucoma. Patients with dialysis had a higher risk of glaucoma (adjusted hazard ratio (aHR): 1.270; 95% confidence interval (CI): 1.035–1.560) than patients without dialysis. The incidence rate of glaucoma was 8.18 per 10,000 person months in the dialysis group, which was higher than that in the non-dialysis group (5.01 per 10,000 person months). Patients with dialysis exhibited a significantly higher risk of angle-closure glaucoma (ACG) (aHR: 1.550; 95% CI: 1.074–2.239). In contrast, there was no significant risk of developing open-angle glaucoma or normal-tension glaucoma in dialysis patients. Our data suggest that dialysis patients are more susceptible to ACG. Regular ophthalmic examinations may be useful in patients with dialysis to identify high-risk individuals with glaucoma, and preventive measures can be applied to avoid permanent vision loss as soon as intraocular pressure (IOP) elevation is identified.

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“…Mannitol infusion has been tried during dialysis, but this exposes the patient to adverse side effects such as—chest pain, headaches, edema, and rashes . The most recent therapy involved an infusion of 20% hyperosmolar glucose solution at 100 mL/h during dialysis which helped maintain the IOP in the normal range …”

Section: Discussionmentioning

confidence: 99%

“…18 The most recent therapy involved an infusion of 20% hyperosmolar glucose solution at 100 mL/h during dialysis which helped maintain the IOP in the normal range. 19,20 Minguela et al presented a case report showing that a change total conductivity with colloid solution can relieve symptoms and prevent increase in IOP. 21 We present the only reported case that used a higher sodium concentration of dialysis to raise tonicity thereby mitigating IOP fluctuations and risk for ocular dialysis disequilibrium.…”

Section: Changing the Tonicitymentioning

confidence: 99%

Ocular dialysis disequilibrium—Management of intraocular pressure during hemodialysis of open angle glaucoma: A case report and review of the literature

Lippold

Kalarn

Swamy

et al. 2019

Hemodialysis International

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It has been shown that patients with end‐stage renal disease (ESRD) have an increased risk for changes in intraocular pressure during hemodialysis, or ocular dialysis disequilibrium which can cause pain or discomfort during treatment and lead to decreased vision over time. This is a case of an elderly male with ESRD who was having headaches, nausea, and eye pain during hemodialysis due to increased intraocular pressures. Using a higher sodium prescription resolved his symptoms and normalized his intraocular pressures. This case illustrates that modification in dialysate tonicity can decrease changes in intraocular pressures while patients are on hemodialysis, a vision saving consideration for patients.

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Management of intraocular pressure elevation during hemodialysis of neovascular glaucoma: a case report

Cited by 12 publications

References 20 publications

Effect of Hemodialysis on Eye Coats, Axial Length, and Ocular Perfusion Pressure in Patients with Chronic Renal Failure

Effect of Hemodialysis on Eye Coats, Axial Length, and Ocular Perfusion Pressure in Patients with Chronic Renal Failure

Risk of Glaucoma in Patients Receiving Hemodialysis and Peritoneal Dialysis: A Nationwide Population-Based Cohort Study

Ocular dialysis disequilibrium—Management of intraocular pressure during hemodialysis of open angle glaucoma: A case report and review of the literature

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