Recurrent Choroidal Detachment in Peritoneal Dialysis Patient With Hypervolemia and Dilutional Hypoalbuminemia

Abstract

The following presents a case of recurrent choroidal detachments (CD) correlated with changes in serum albumin levels and the patient's fluid status. A 71-year-old female patient presented with a 4-day history of blurry vision in her left eye. Pertinent medical history included end-stage renal disease treated with continuous ambulatory peritoneal dialysis. Previously, the patient's left eye was treated for primary angle-closure glaucoma by trabeculectomy. While this resulted in a low baseline intraocular pressure (IOP) of 2 to 7 mm Hg, the patient never developed any hypotony-related complications for the past 6 years. After examination, CD was diagnosed and treated with transscleral surgical drainage. The patient further developed 2 additional episodes of CD in the same eye. All episodes were also associated with bilateral pitting edema, weight gain, and hypoalbuminemia. Thus, the patient was recommended to take a protein supplement and limit her fluid intake. In addition, the dialysis treatment regimen was altered to achieve greater daily fluid removal. After 12 weeks, there was no recurrent episode of CD, and the patient was clinically stable with a final visual acuity of 20/30 and an IOP of 3 mm Hg. The serum albumin levels improved slightly, and there were no signs of hypervolemia. In this case of recurrent CD, a possible association between the development of CD, hypoalbuminemia, and hypervolemia in patients with end-stage renal disease is demonstrated. Clinicians should be aware that these systemic factors can be tied with recurrent CDs, especially among patients with a low baseline IOP.