Skip to main content
SpringerLink
Log in

Sequential nonarteritic anterior ischemic optic neuropathy in patient on chronic hemodialysis

  • Case Report
  • Published:
CEN Case Reports Aims and scope Submit manuscript

Abstract

Nonarteritic anterior ischemic optic neuropathy (NAION) is a well acknowledged rare complication of chronic hemodialysis in patients with end-stage renal disease (ESRD). We present a unique case of a patient on chronic hemodialysis who presented with an NAION in the right eye, then 3 months later developed an NAION in the left eye followed in 1 month by second NAION episode in the left eye. Every episode of NAION was accompanied by intradialytic hypotension (drop in systolic blood pressure of over 20 mmHg) where visual loss was noticed at the end of the dialysis session. Clinicians should be aware of association between NAION and hemodialysis and that patients with dialysis-induced hypotension are at particularly increased risk of having NAION. Patients who had dialysis-associated NAION should be closely monitored to prevent occurrence of intra-dialytic hypotension as they are at the highest risk of sequential NAION and thus severe visual loss.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hattenhauer MG, Leavitt JA, Hodge DO, Grill R, Gray DT. Incidence of nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol. 1997;123(1):103–7.

    Article  CAS  PubMed  Google Scholar 

  2. Jacobson DM, Vierkant RA, Belongia EA. Nonarteritic anterior ischemic optic neuropathy. A case–control study of potential risk factors. Arch Ophthalmol. 1997;115(11):1403–7.

    Article  CAS  PubMed  Google Scholar 

  3. Burde RM. Optic disk risk factors for nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol. 1993;116(6):759–64.

    Article  CAS  PubMed  Google Scholar 

  4. Olver JM, Spalton DJ, McCartney AC. Microvascular study of the retrolaminar optic nerve in man: the possible significance in anterior ischaemic optic neuropathy. Eye (Lond). 1990;4(Pt 1):7–24.

    Article  Google Scholar 

  5. Newman NJ, Scherer R, Langenberg P, Kelman S, Feldon S, Kaufman D, et al. The fellow eye in NAION: report from the ischemic optic neuropathy decompression trial follow-up study. Am J Ophthalmol. 2002;134(3):317–28.

    Article  PubMed  Google Scholar 

  6. Hayreh SS, Podhajsky PA, Zimmerman B. Ipsilateral recurrence of nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol. 2001;132(5):734–42.

    Article  CAS  PubMed  Google Scholar 

  7. Servilla KS, Groggel GC. Anterior ischemic optic neuropathy as a complication of hemodialysis. Am J Kidney Dis. 1986;8(1):61–3.

    Article  CAS  PubMed  Google Scholar 

  8. Hamed LM, Winward KE, Glaser JS, Schatz NJ. Optic neuropathy in uremia. Am J Ophthalmol. 1989;108(1):30–5.

    Article  CAS  PubMed  Google Scholar 

  9. Haider S, Astbury NJ, Hamilton DV. Optic neuropathy in uraemic patients on dialysis. Eye (Lond). 1993;7(Pt 1):148–51.

    Article  Google Scholar 

  10. Korzets A, Marashek I, Schwartz A, Rosenblatt I, Herman M, Ori Y. Ischemic optic neuropathy in dialyzed patients: a previously unrecognized manifestation of calcific uremic arteriolopathy. Am J Kidney Dis. 2004;44(6):e93–7.

    Article  Google Scholar 

  11. Nieto J, Zapata MA. Bilateral anterior ischemic optic neuropathy in patients on dialysis: a report of two cases. Indian J Nephrol. 2010;20(1):48–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Bartlett S, Cai A, Cairns H. Non-arteritic ischaemic optic neuropathy after first return to haemodialysis. BMJ Case Rep. 2011. https://doi.org/10.1136/bcr.04.2011.4072.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Basile C, Addabbo G, Montanaro A. Anterior ischemic optic neuropathy and dialysis: role of hypotension and anemia. J Nephrol. 2001;14(5):420–3.

    CAS  PubMed  Google Scholar 

  14. Kooman J, Basci A, Pizzarelli F, Canaud B, Haage P, Fouque D, et al. EBPG guideline on haemodynamic instability. Nephrol Dial Transplant. 2007;22(Suppl 2):ii22–44.

    PubMed  Google Scholar 

  15. Sands JJ, Usvyat LA, Sullivan T, Segal JH, Zabetakis P, Kotanko P, et al. Intradialytic hypotension: frequency, sources of variation and correlation with clinical outcome. Hemodial Int. 2014;18(2):415–22.

    Article  PubMed  Google Scholar 

  16. Al Zubidi N, Zhang J, Spitze A, Yalamanchili S, Lee AG. Pallid disc edema and choroidal perfusion delay in posthemodialysis nonarteritic ischemic optic neuropathy. Can J Ophthalmol. 2013;48(5):e120–3.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Toronto, Department of Ophthalmology and Vision Sciences, 801 Eglinton Ave West Suite 301, Toronto, ON, M5N 1E3, Canada

    Ari Shemesh & Edward Margolin

Authors
  1. Ari Shemesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edward Margolin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edward Margolin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

Not applicable.

Informed consent

Not applicable, no identifying information presented.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shemesh, A., Margolin, E. Sequential nonarteritic anterior ischemic optic neuropathy in patient on chronic hemodialysis. CEN Case Rep 8, 89–94 (2019). https://doi.org/10.1007/s13730-018-0372-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13730-018-0372-8

Keywords

Search

Navigation