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Abstract: PO1069

Hemodialysis-Associated Increased Intraocular Pressure: A Vision-Threatening Complication

Session Information

Category: Trainee Case Report

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Lewis, Chad York, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, United States
  • Batra, Nikhil, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
  • Steffen, Eric A., Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
  • Graber, Martha L., Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
Introduction

Elevation of intraocular pressure (IOP) is a potential complication of hemodialysis (HD). When patients with risk factors for angle closure undergo HD, aqueous humor volume may increase, thus elevating IOP.

Case Description

A 71M with ESRD secondary to type II diabetes and proliferative diabetic retinopathy reported one month of headache, left-sided eye pain and photophobia, and periorbital redness occurring with dialysis. Ophthalmology diagnosed neovascular glaucoma following an elevated IOP of 36 mmHg in the left eye (normal < 22). Pre-dialysis IOP returned to normal with medical therapy. Dialysis modifications reduced the rate and magnitude of change in plasma osmolality (Table 1). However, elevated IOP and symptoms persisted and he underwent surgery on 5/6/2020 with full resolution of symptoms.

Discussion

Sitprija et al. (1964) first observed increased IOP during HD in 83 of 89 cases. Subsequent studies report that IOP may increase, decrease, or remain unchanged during HD. One proposed mechanism for increased IOP is as plasma urea is reduced, the aqueous humor lags, becoming hypertonic relative to plasma. The choroid may also thicken, obstructing outflow. We increased dialysate sodium and reduced HD time and dialysate flow. Other strategies include infusing mannitol or hyperosmolar glucose, ultrafiltration to increase plasma oncotic pressure, and more frequent or peritoneal dialysis. Nephrologists should have heightened awareness for angle-closure glaucoma and conditions predisposing to obstruction of aqueous outflow, including proliferative diabetic retinopathy. Headache, ocular pain, or visual changes during dialysis warrant urgent ophthalmic evaluation.

Table 1
DatePre-HD IOP
(R/L; mmHg)
IOP 3 hrs. into HD
(R/L; mmHg)
Net Δ in IOP
(R/L; mmHg)
% Δ in IOP (R/L)
4/25/209/1212/25+3/+13+33%/+108%
4/29/2012/2516/33+4/+8+33%/+32%
5/25/2013/1215/16+2/+4+15%/+33%

Optical coherence tomography on 4/23/20