Sequential nonarteritic anterior ischemic optic neuropathy in patient on chronic hemodialysis
- 55 Downloads
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.
KeywordsNonarteritic anterior ischemic optic neuropathy Dialysis-induced hypotension Blindness after dialysis
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
Not applicable, no identifying information presented.
- 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.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.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