Exudative retinal detachment secondary to hypertensive crisis related to membranous nephropathy

Abstract

The present case can provide guidance for following patients with CS in the eye clinic. Retinitis pigmentosa is detected commonly in these patients. 2 Routine OCT may inform treatment decisions given that topical carbonic anhydrase inhibitors may improve CME in retinal dystrophies. 5 In addition to OCT, electroretinogram findings can help characterize and explain vision loss, which is critical as these patients may not verbalize visual complaints. Finally, refractive error should be frequently assessed given that progressive myopia is virtually always present. 2 To further explore the experience with CS among Canadian ophthalmologists, we undertook a survey study. This was approved by the Queen's University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board. The survey (Appendix) was developed using Qualtrics (Provo, UT) and distributed to members of the Canadian Association of Pediatric Ophthalmology and Strabismus by email listserv (76 members).Responses were received from 19 pediatric ophthalmologists (response rate, 25%), with a median of 12 years of practice (range, 2À40 years). Respondents were asked to rate how knowledgeable they were of CS. Three (15.8%) rated "not at all," 5 (26%) "minimally," 10 (53%) "somewhat," 1 (5%) "very," and 0 "extremely." Only 8 (41%) had seen at least 1 patient with CS over their entire career. The range of number of patients ever seen by each ophthalmologist was 0À4. Only 4 respondents (21%) currently follow a patient with this diagnosis in their practice. Among those, only 1 patient has been assessed by ophthalmology before a diagnosis of CS was known; this is the patient herein reported. While limitations of this study include low response rate, potential recall bias, and patients possibly being double-counted if shared between practices, these do not alter our conclusions.Pediatric ophthalmologists in Canada have limited exposure to CS in clinical practice and almost exclusively encounter these patients after the diagnosis has been made. Almost half of pediatric ophthalmologists surveyed believed that they were either not at all or only minimally knowledgeable of CS. This underscores the value of reports describing clinical findings of this rare disease, especially early in its natural history. In the context of myopia, pigmentary retinal changes, undefined developmental delay, and dysmorphic features, an ophthalmologist may be among the first providers with opportunity to initiate referral for genetic testing. This, in turn, has large implications for management of vision loss and family expectations.

Giant retinal pigment epithelium tears with membranous nephropathy: a case report and literature review

“…Patients with end-stage renal disease on dialysis have a high risk of exudative retinal detachments [ 8 ]. Till now, a case of exudative retinal detachment secondary to a hypertensive crisis related to membranous nephropathy [ 9 ] and a case of choroidal neovascularization in a patient with primary membranous nephropathy have been reported [ 10 ]. However, membranous nephropathy-related retinal pigment epithelium tears have not yet been reported.…”