Abstract: FR-PO0745
Bilateral Asymmetric Ischemic Optic Neuropathy in a Child on Hemodialysis
Session Information
- Pediatric Nephrology: CKD, ESKD, and Glomerular Diseases
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Tollaksen, Ross A., Children's Hospital at Montefiore, New York, New York, United States
- Lal, Kirshan, Children's Hospital at Montefiore, New York, New York, United States
- Amin, Mohammed, Children's Hospital at Montefiore, New York, New York, United States
- Mishra, Aparajita, Children's Hospital at Montefiore, New York, New York, United States
- Wieder, Matthew S, Montefiore Einstein Medical Center, New York, New York, United States
- Zolotnitskaya, Anna, Children's Hospital at Montefiore, New York, New York, United States
Introduction
Ischemic optic neuropathy (ION) is extremely rare in children, often linked to systemic illnesses or associated with risk factors such as abnormal blood pressure, coagulopathy, anemia, and renal failure. Pediatric ION related to dialysis is exceedingly uncommon, with dialysis-induced blood pressure changes and anemia potentially contributing to optic nerve ischemia and blindness. This case describes a 13-year-old male who developed ION secondary to hypotension during hemodialysis (HD) and was later found to have anatomical changes on retinal examination.
Case Description
A 13-year-old with ESRD on maintenance hemodialysis developed sudden left-eye vision loss after routine HD, prompting ED evaluation and hospital admission after negative stroke evaluation. Dilated ophthalmic exam revealed left > right disc edema with vascular tortuosity and acute superior branch retinal artery occlusion (BRAO) of the left eye. Retinal angiography showed delayed filling and transit of the superotemporal arcade in the left eye with disc hyperfluorescence left > right, suggesting the right eye was affected. Persistent hypotension, especially while undergoing HD, required PICU transfer for vasopressor support and continuous renal replacement therapy. Ultimately, the patient was diagnosed with a right anterior ION and combined left anterior and posterior ION with BRAO.
Discussion
While there are few case reports describing ION in pediatric patients, the majority of reported patients were undergoing chronic dialysis. Furthermore, our case demonstrates the risk of changes in blood pressure contributing to ION development. In our case, fundoscopy revealed mild optic disc edema in the right eye and severe optic disc edema in the left eye, consistent with bilateral ION. At last, follow up retained right eye vision with mild peripheral field loss but had permanent left-eye blindness despite intensive treatment.