Recurrent Intraocular Pressure Elevation During Hemodialysis in a Patient with Neovascular Glaucoma

Song, Won Kyung; Ha, Sol; Yeom, Ho Yeup; Seoung, Gong Jae; Hong, Young Jae

doi:10.3341/kjo.2006.20.2.109

Cited by 20 publications

(16 citation statements)

References 17 publications

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“…Intraocular pressure (IOP) is a major risk factor for development and progression of glaucomatous disease, and transient increases in IOP have been reported during HD in patients with and without glaucoma. [3][4][5][6][7][8][9][10][11][12] The meaning of significant but transient IOP elevation during HD sessions, in terms of risk of glaucoma development and progression, is not known.…”

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confidence: 99%

Effect of Hemodialysis on Intraocular Pressure and Ocular Perfusion Pressure

Bui

Patel

et al. 2013

JAMA Ophthalmol

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IMPORTANCE Elevated intraocular pressure (IOP) and decreased ocular perfusion pressure (OPP) are risk factors for glaucoma development and progression. Unrecognized significant IOP elevation or OPP reduction during hemodialysis (HD) could lead to glaucomatous optic nerve damage and subsequent visual loss. OBJECTIVE To evaluate changes in IOP and OPP during HD. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional observational study was conducted in patients undergoing HD at an ambulatory care clinic at the University of Illinois at Chicago. EXPOSURES Forty-nine patients (97 eyes) undergoing HD were enrolled. Exclusion criteria included preexisting corneal abnormalities, history of corneal surgery, allergy to topical anesthetic agents, and current eye infection. Nine patients had previous diagnoses of open-angle glaucoma (OAG) or suspected glaucoma. At 3 time points, IOP was measured using a pneumatonometer and blood pressure was recorded. Measurements were made with the patient in a seated position approximately 15 minutes before starting HD (T1), approximately 2 hours after starting HD (T2), and approximately 15 minutes after ending HD (T3). Mean arterial pressure (MAP) and OPP (systolic, diastolic, and mean OPP) were calculated. MAIN OUTCOMES AND MEASURES Intraocular pressure and OPP. RESULTS From T1 to T3, IOP significantly increased by 3.1 mm Hg (both eyes, P < .001), MAP significantly decreased by 5.8 mm Hg (P = .05), and all OPP measures significantly decreased from baseline (all P Յ .02). Using previously reported thresholds of increased glaucoma development and progression risk, 53% of the right eyes (26 of 49) and 46% of the left eyes (22 of 48) had a systolic OPP of 101 mm Hg or less, 71% of the right eyes (35 of 49) and 73% of the left eyes (35 of 48) had a diastolic OPP of 55 mm Hg or less, and 63% of the right eyes (31 of 49) and 65% of the left eyes (31 of 48) had a mean OPP of 42 mm Hg or less. CONCLUSIONS AND RELEVANCE Significantly increased IOP and decreased OPP occur during HD, bringing both to levels that increase the risk of glaucoma development and progression. Clinicians should consider HD history in patients who have glaucoma progression, even when IOP has been well controlled. Such patients may benefit from IOP and blood pressure monitoring during HD sessions to minimize OPP changes resulting from IOP spikes and/or suboptimal blood pressure.

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confidence: 99%

Effect of Hemodialysis on Intraocular Pressure and Ocular Perfusion Pressure

Bui

Patel

et al. 2013

JAMA Ophthalmol

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“…However, these drugs cause electrolyte imbalances and metabolic acidosis, and although medication has been reported to be effective by some, in our patient, medication prior to HD did not prevent IOP elevation associated severe ocular pain. In addition, there are a limited number of surgical reports, such as, argon laser trabeculoplasty for exfoliative glaucoma [7], Ahmed valve implantation for neovascular glaucoma [15], and trabeculectomy for diabetic retinopathy [16] associated with IOP elevation during HD.…”

Section: Discussionmentioning

confidence: 99%

Recurrent symptomatic intraocular pressure spikes during hemodialysis in a patient with unilateral anterior uveitis

2013

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BackgroundThe relationship between intraocular pressure (IOP) changes and hemodialysis has been evaluated for several decades. However, no report on an IOP rise in uveitis patients during hemodialysis has been previously documented. This report describes the case of an uveitis patient with repetitive IOP spikes associated with severe ocular pain during hemodialysis sessions, which resolved after glaucoma filtering surgery.Case presentationA 47-year-old male with diabetes and hypertension had complained of recurrent ocular pain in the left eye during hemodialysis sessions. A slit-lamp examination showed diffuse corneal epithelial edema with several white keratic precipitates and inflammatory cells (Grade 3+) in the anterior chamber of the left eye. No visible neovascularization or synechiae were visible on the iris or angle. Topical glaucoma eye-drops and intravenous mannitol before hemodialysis did not prevent subsequent painful IOP spikes in the left eye. At the end of hemodialysis, IOP averaged ~40 mmHg. After trabeculectomy with mitomycin C in the left eye, his IOP stabilized in the low-teens (range, 10–14 mmHg) and no painful IOP spikes occurred during hemodialysis over the first postoperative year.ConclusionWe present a case of recurrent painful IOP spikes during hemodialysis in a patient with unilateral anterior uveitis unresponsive to conventional medical treatment prior to hemodialysis. To our knowledge, this is the first case report of repetitive symptomatic IOP rise during hemodialysis in an uveitic glaucoma patient. This case highlights the importance of the awareness of the possibility that IOP may rise intolerably during hemodialysis in uveitis patients with a compromised outflow facility.

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“…Systemic hemodynamic parameters, as well as eye fluid volume and composition, can change with HD. There are many studies examining the anterior and posterior segment showed significant changes in IOP and CCT (8)(9)(10)(11)(12). Given the contradictory reports of HD affecting IOP, precise and mechanistic insights of HD on IOP are not well-established (11,13,14).…”

Section: Introductionmentioning

confidence: 99%