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Kidney Week

Abstract: PO0902

Transient, Severe, Unilateral Eye Pain and Vision Loss Associated with Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Author

  • Diab, Anas, WVU Nephrology, Morgantown, West Virginia, United States
Introduction

Acute on chronic angle-closure glaucoma with elevated intraocular pressure is a well-established etiology of severe eye pain and profound vision loss, if not treated emergently. This case is a recurrent and episodic eye pain with transient visual loss during HD.

Case Description

64 year-old Caucasian female with comorbidities including poorly-controlled insulin dependent type 2 diabetes, uncontrolled hypertension, obesity. She is on intermittent hemodialysis three times weekly the last 5 years. She was previously followed by a retina specialist for proliferative diabetic retinopathy with subsequent neovascular glaucoma. Initial onset approximately 1 year prior, with episodic pain and blurred vision with severe eye pain and complete unilateral vision loss start at initiating dialysis, symptoms resolved with cessation of treatment. Due to worsening pain symptoms, patient compliance becomes an issue, leading to frequent missing Dialyiss and Pulm edema required hospitalization. A glaucoma specialist, diagnosed neovascular glaucoma of the right eye. Maximal topical and oral tolerated medical therapy was started, but her disease was refractory to conservative management.
Surgical intervention was pursued,Valved Drainage Device (New World Medical) was placed under topical anesthesia. Post-operatively, the patient was able to undergo dialysis sessions without ocular symptoms and compliance has improved.

Discussion

The effect of hemodialysis (HD) on intraocular pressure (IOP) is variable and the exact mechanisms are still not clear. Previous reports in the literature suggest both increased and decreased intraocular pressure during fluid shifts associated with hemodialysis.
Argon Pan-retinal laser photocoagulation is known to reduce angle neovascularization induced by peripheral retinal ischemia in Neovascular glaucoma patients , IOP reduction is typically achieved with topical and systemic medications . Shunting and filtering procedures, including glaucoma valve implants and trabeculectomy surgery, may restore outflow and reduce IOP . After appropriate surgical intervention, the patient reported resolution of symptoms and improved tolerance to dialysis sessions.