Bullous retinal detachment and multiple retinal pigment epithelial detachments in patients receiving hemodialysis

Abstract

Two patients receiving hemodialysis for chronic renal failure developed bilateral bullous retinal detachment associated with multiple underlying serous detachments of the pigment epithelium. Many of the detachments of the pigment epithelium were surrounded by subretinal whitish exudate that was probably fibrinous in type. There was fluorescein angiographic evidence of dehiscence of the pigment epithelium at the margin of some of the pigment epithelial detachments. Failure to recognize the nature of the retinal detachment in one patient resulted in an unsuccessful scleral buckling procedure.

Photodynamic therapy for bullous retinal detachment: a single-center experience of case series with a 6-month follow-up study

“…Previous studies have shown an association between retinal disease and retinal or cardiac transplantation with the bullous variant of CSC [24, 25]. Corticosteroids also have been implicated in the pathogenesis of bullous retinal detachment [7, 26].…”

Risk of serous retinal detachment in patients with end-stage renal disease on dialysis

“…The association between having ESRD while on dialysis and serous retinal detachment has been reported by several studies [22–26]. Goldstein presented a case report where a patient with chronic renal failure developed into bullous serous retinal detachment and informed ophthalmologists and nephrologists the possibility of bullous serous retinal detachment [26].…”

“…However, the underlying mechanism of the association between ESRD while on dialysis and serous retinal detachment has been controversial. Gass suggested that renal failure plays a more important role than dialysis in the pathophysiology of serous retinal detachment [22]. Because the fibrinous exudates were found beneath the margins of the dehiscent pigment epithelium and surrounding sub-retinal space, Gass hypothesized that large molecules, like fibrinogen, could enter the sub-retinal space.…”

“…The occurrence of serous retinal detachment has been described in patients receiving haemodialysis in several previous reports [22–24]. However, the underlying mechanism of serous retinal detachment is not well understood and controversial.…”

“…Although Gass has suggested that the uraemic state is more important than haemodialysis in the development of serous retinal detachment [22], Troiano et al hypothesized that haemodialysis is the more important cause of the phenomenon [23]. In addition, previous studies that discussed the association between ESRD treated with dialysis and serous retinal detachment were limited by the small number of patients or the absence of comparative control data [12,13,22–24]. By using a nationwide population-based dataset, we designed a cohort study to investigate the risk of serous retinal detachment in patients with ESRD on dialysis in Taiwan.…”