Ophthalmic manifestations of epidemic nephropathy

Abstract

An ophthalmic examination was performed on 29 epidemic nephropathy patients consequently treated in the Central Hospital of Central Finland during the acute phase of the disease. Twenty-six of those patients were reexamined after an interval of one month. In the acute phase of the disease pathological ophthalmic changes were found in 15 cases (52%). The symptoms observed were conjunctival injection, oedema, flare and cell reaction in anterior chamber, anisochoria, retinal oedema, acute glaucoma and myopic shift of refraction. The main effect of disease on intraocular pressure was pressure-lowering. The myopic shifts were not dependent on initial refraction. In one case of acute glaucoma this shift could be explained by swelling and forward movement of the lens.

Prospective study on ocular findings in acute Puumala hantavirus infection in hospitalised patients

“…This finding does not support the previous hypothesis that the depth of the anterior chamber plays a major role in the mechanism of myopia 18. Another commonly discussed feature claimed to account for the myopic shift is thickening of the lens 16 18. In our study, thickening of the lens was noted in 82% of all NE cases encompassing the patients with a myopic refraction change.…”

“…Previous reports have examined the ophthalmic aspects of NE mainly in patients with mild or moderate systemic disease 16 18–20. However, controversy exists on some findings, such as changes in IOP, possibly due to variation in time points at which the ocular findings were recorded during the course of the illness in the earlier studies.…”

“…Reduced vision, which is highly characteristic of NE, is commonly thought to be caused by a myopic shift or transient myopia,16 18 although the precise mechanism of visual disturbance has remained unknown. Compared with previous studies, the greater incidence of myopic refraction change in the current study may be explained by the severity of the systemic disease in our patients.…”

“…Contradictory results of IOP level in patients with NE have been published,12 15 16 19 23 and there are some reports of acute glaucoma attacks associated with NE 12 15 16 23. The increased IOP has been speculated to be due to oedema and haemorrhage in the ciliary body, its anterolateral rotation, relaxation of the zonules and the anterior movement of the lens 12.…”

“…However, it is difficult to understand the mechanisms of these ocular symptoms, since often the findings are based on case reports9–15 or studies involving groups of patients in very different clinical stages of the disease or different degrees of severity 16–20. For example, controversy exists in understanding of the possible changes in intraocular pressure11–13 15 16 19 as well as in occurrence of anterior uveitis during the acute phase of the disease 10 11 13 15 16 20. Brief reports on ocular symptoms and findings similar to those seen in NE have been described in HFRS caused by other hantaviruses 1 2…”