Titre : | Case Report: Combined Ischemic Optic Neuropathy and Central Retinal Artery Occlusion after Starting Hemodialysis |
Type de document : | article de périodique |
Auteurs : | Emily M. Carell |
Année de publication : | 2021 |
Langues : | Français (fre) |
Descripteurs (mots clés) : | [Thésaurus Mesh]:D:Dialyse rénale:Dialyse rénale / effets indésirables [Thésaurus Mesh]:N:Neuropathie optique ischémique:Neuropathie optique ischémique / étiologie [Thésaurus Mesh]Dialyse rénale [Thésaurus Mesh]Neuropathie optique ischémique [Thésaurus Mesh]Occlusion artérielle rétinienne [Thésaurus HELB]:Optique:Perte de vision
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Résumé : | SIGNIFICANCE: This case highlights ocular ischemia after hemodialysis resulting in permanent vision loss. Fifteen
percent of the U.S. population suffers from chronic kidney disease. Eye care providers should recommend risk factor
modifications to their patients with end-stage renal disease before hemodialysis is started to prevent loss of vision.
PURPOSE: The purpose of this study was to demonstrate a case of concurrent nonarteritic anterior ischemic optic
neuropathy and central retinal artery occlusion in the setting of hemodialysis initiation.
CASE REPORT: A 68-year-old Irish man with end-stage renal disease undergoing dialysis presented, complaining
of 3 weeks of progressive vision loss in his left eye. His medical history is complex and includes extensive cardiac
disease, bilateral carotid stenosis, and peripheral vascular disease. His surgical history includes a right carotid endarterectomy, bilateral lower extremity amputations, and an aortic valve replacement. Clinical examination revealed
light perception vision with an afferent pupillary defect in the left eye and count finger peripheral vision only in the
superior temporal quadrant of his vision. The dilated fundus examination showed significant pallid disc edema and
focal areas of retina whitening with attenuated peripapillary vasculature in the left eye. This edema was confirmed
by optical coherence tomography and supported optic nerve and retinal infarction. A temporal artery biopsy confirmed no evidence of arteritis.
CONCLUSIONS: Hemodynamic disruption during dialysis in patients with end-stage renal disease and overlying
anemia can result in optic nerve and retinal infarction. Patients who are predisposed to nonarteritic anterior ischemic optic neuropathy or central retinal artery occlusion should be educated on this before starting dialysis to ensure
careful blood pressure monitoring. |
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