Previous ischaemic optic neuropathy in haemodialysis
Neuropatía óptica isquémica anterior en hemodiálisis
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Marinaro" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Luis Roberto" "apellidos" => "León" "email" => array:1 [ 0 => "lleon@intramed.net.ar" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "C." "apellidos" => "Marinaro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "DIAVERUM, CERER, S.A., San Justo, Buenos Aires, Argentina, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neuropatía óptica isquémica anterior en hemodiálisis" ] ] "textoCompleto" => "<p class="elsevierStylePara">Dear Editor,</p><p class="elsevierStylePara">Optic neuropathy is a syndrome and not a mere common injury of the optic nerve; its aetiology is broad and greatly varies. Ischaemic optic neuropathies influenced by local and systemic factors are particularly noteworthy, many of which are difficult to understand. These processes occur in the field of other specialisations with surgical manoeuvres and/or aggressive diagnoses, in which the patient is compromised, as the initial diagnosis could be problematic.<span class="elsevierStyleSup">1</span> Ophthalmologists are well aware of the process, however, doctors of other specialisations do not realise the possibility for this clinical condition, being familiar with its existence only when it appears. Various risk factors exist for ischaemic optic neuropathy (ION), however, we must emphasise sudden hypotension, which does not allow for the autoregulation mechanisms of the optic nerve to compensate, particularly if the patient suffers from previous hypotension, anaemia, sudden and/or recurrent haemorrhage, serious facial oedema, chronic kidney disease, bleeding surgeries and, generally, all situations associated with arteriosclerosis.</p><p class="elsevierStylePara">Based on the few reports in the literature of patients with chronic kidney disease (CKD), we report the cases of 2 patients in haemodialysis with a diagnosis of acute bilateral loss of vision due to a previous ischaemic optic neuropathy (PION).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case 1</span></p><p class="elsevierStylePara">A 29-year-old woman with a diagnosis of CKD owing to GEFS was hospitalised for haemodialysis at the age of 25. Three years after the haemodialysis, she showed signs of severe secondary hyperparathyroidism (SHPT) with PTH i > 1,000pg/ml, ostealgia, asthenia, pruritus and persistent symptomatic hypotension. There were no arterial or cardiovascular calcifications. A diagnostic ultrasound of the parathyroid glands was carried out with no visualisation with 99Tc and MIBI with diffuse increase in the fixation of the left and right inferior parathyroid lobes. Treatment for the SHPT was carried out with calcium binders and intermittent calcitriol IV for hyperphosphatemia. Subtotal parathyroidectomy was prescribed, taking into consideration the patient¿s age and transplant suitability. The previous laboratory results were as follows: HCT 37%, Hb 12.1, Ca 9mg/dl, P 6mg/dl, K 5 meq/l. Normal coagulation test results. Biopsy of the parathyroid glands: bilateral hyperplasia. During the surgery she developed hypotonia (average BP of 90/60). Six days following surgery, she experienced partial loss of vision in the RE and total in the LE, mild hypocalcaemia and symptomatic hypotension. Laboratory: HCT 36%, Hb 12, Ca 6.3, Ca i 0.2l, P 3.5 and Mg 1.9. The hypocalcaemia values were corrected.</p><p class="elsevierStylePara">Normal results of the collagen and coagulation tests. Results of anticardiolipin antibodies, lupus anticoagulant, ANCAp and c and serology for toxoplasmosis and syphilis were negative.</p><p class="elsevierStylePara">Neurological examination was carried out, showing right nasal hemianopsia and vision restricted to profiles on the left eye. Discus-shaped pupil in the RE and LE at<span class="elsevierStyleSup">3</span> and 4mm, respectively. Ophthalmological examination: AV with vision, counted fingers at 50cm in the LE and slight drop in vision in the RE. A reactive mydriasis in the LE and reactive in the RE. Inner eye: attached retina, normal macula and congestion of the papilla with degenerative oedema (L and RE) and PO 10/10mmHg. Normal MRI of the brain and bulb. Evoked visual potential in the RE and LE of average range and prolonged central latency, compatible with moderately affected areas of the optical route that is consistent with optic neuropathy. Visual sharpness: 0.5 in the LE and 0.8 in the RE. Campimetry: outwith the normal limits for the LE, with an alteration in the relative feeling and a restriction of the blind spot (increased). There was a total decrease in feeling in the LE.</p><p class="elsevierStylePara">Corticosteroids (prednisone) were prescribed as a treatment at a dose of 1mg/kg/day for 30 days.</p><p class="elsevierStylePara">The papillary oedema increased in both eyes, with a vision restricted to profiles in the RE and amaurosis in the LE.</p><p class="elsevierStylePara">Within two months, an almost total atrophy of the right optical nerve was detected in the inner eye, with dilation and venous tortuosity, while there was total atrophy of the left optical nerve.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case 2</span></p><p class="elsevierStylePara">In 1993, a 25-year-old man with CKD owing to obstructive nephropathy was hospitalised to receive haemodialysis. In November 1995, he was given a renal transplant from a compatible donor. In December 1995, he experienced FAV and received blood transfusions at various times. In September 2003, he was once again admitted to hospital for haemodialysis due to the transplant¿s chronic nephropathy. In the period from 2004-2009 he suffered from multiple blockages of the vascular access.</p><p class="elsevierStylePara">Anaemia with partial response to EPO. Severe SHPT with persistent hyperparathyroidism. Did not follow the diet and took in an excessive amount of fluids, leading to a significant interdialytic excess weight and severe hypotension. Deficient dialysis suitability with minor KTVsp at 1.4. Haematological tests were carried out for his medical history with thrombophilia, consistent with the inhibitory lupus effect and a slightly increased plasma homocysteinemia. Treatment with acetylsalicylic acid, folic acid + vitamin B complex and anticoagulation was administered. A short anticoagulant treatment was administered for lack of performance.</p><p class="elsevierStylePara">In March 2009, the patient showed symptoms of loss of vision in the RE and partial loss of vision in the LE. Inner eye: with bilateral papillary oedema. Normal ocular pressure. There is no medical history of headaches. Normal MRI of the brain. Neurological examination: negative AV light, abolished reflexes (areactive mydriasis). Inner eye: diffuse-edge papilla with papillary oedema + (no haemorrhage) (LE), diffuse- edge papilla with papillary oedema+++. Visual PE with severely affected areas of the optical route that is consistent with optic neuropathy. Results of laboratory tests: HCT 26, Hb 8.1, Upre 129,Upost 18, P 6.9, Ca 8.2 and PTH 2.431. Normal results for connective disease tests. Normal values for anticardiolipin IgG and IgM. Results of ANCAp and c and serology for HBs Ag, HCVAc, HIV, toxoplasmosis and syphilis were negative.</p><p class="elsevierStylePara">Beginning of treatment with: corticosteroids (prednisone) at a dose of 1mg/kg/day, with no response at 30 days. Inner eye test (2 months), bilateral atrophy. The patient is clinically damaged with bilateral amaurosis.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussion</span></p><p class="elsevierStylePara">We have come across 16 cases of PION in patients with substitutive renal treatment, 10 of which correspond to patients following a programme of periodic haemodialysis <span class="elsevierStyleSup">2-13</span> and the rest to DPCA.<span class="elsevierStyleSup">11,12</span> In general, all cases shared a medical history of hypotension episodes in dialysis,<span class="elsevierStyleSup">2,8,13</span> one of which showed no hypotension,<span class="elsevierStyleSup">9</span> while another was associated to Sildenafil.<span class="elsevierStyleSup">10</span> The visual deficit was bilateral, and in 15 of the cases it manifested as anterior ischemic optic neuropathy, with only one case showing it afterwards. They showed a partial response to a corticosteroids dose. In the cases presented, we could not avoid thinking about the possible association of severe secondary hyperparathyroidism with calcific uremic arteriolopathy (calciphylaxis) in arterioles that moisten the optic nerve. Korzets et al<span class="elsevierStyleSup">13</span> observed an acute loss of vision in 2 patients with a diagnosis of PION, a biopsy of the choroid of the temporal artery of whom showed signs of hypotension and calcification, taking into account that hypoperfusion could have occurred from calciphylaxis of the arterioles moistening the top of the optic nerve. Furthermore, the association of the ischaemic ocular pathology with the antiphospholipid syndrome is well known,<span class="elsevierStyleSup">14,15</span> as shown in the second case, where the patient has clinical and laboratory symptoms of primary antiphospholipid syndrome (PAPS), and in which the ocular affectation associated with the presence of these symptoms includes vaso-occlusive retinopathy, estimated to be present in 29% of the patients with PAPS, and optic neuropathy of a likely ischaemic nature. </p>" "pdfFichero" => "P-E-S-A459-EN.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Connolly SE, Gordon KB, Horton JC. Salvage of vision after hypotension-induc ischemic optic neuropathy. AJO 1994;117:235-42." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Servilla KS, Groggel GC. Anterior ischemic optic neuropathy as a complication of hemodialysis. Am J Kidney Dis 1986;8:61-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/3728463" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Haider S, Astbury NJ, Hamilton DV. Optic neuropathy in uraemic patients on dialysis. Eye 1993;7:148-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8325406" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Connolly SE, Gordon KB, Horton JC. Salvage of vision after hypotensioninduced ischemic optic neuropathy. Am J Ophthalmol 1994;117:235-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8116753" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Koos MJ, Munteanu G. Anterior ischemic optic neuropathy after systemic hypotension and anemia. Oftalmología 1998;44:79-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10418618" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Sabeel A, Al-Hazzaa SA, Alfurayh O, Mikkonen P. The dialysed patient who turned blind during a haemodialysis session. Nephrol Dial Transplant 1998;13:2957-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9829514" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Basile C, Addabbo G, Montanaro A. Anterior ischemic optic neuropathy and dialysis: role of hypotension and anemia. J Nephrol 2001;14:420-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11730278" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Buono LM, Foroozan R, Savino PJ, Danesh-Meyer HV, Stanescu D. Posterior ischemic optic neuropathy after hemodialysis. Ophthalmology 2003;110:1216-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12799249" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cuxart M, Matas M, Picazo M, Sans R, Juvanet J, Osuna T. Pérdida visual bilateral aguda en paciente en hemodiálisis. Nefrología 2005;25(6)." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gedik S, Yilmaz G, Akova YA. Sildenafilassociated consecutive nonarteriticanterior ischaemic optic neuropathy, cilioretinal artery occlusion, and central retinal vein occlusion in a haemodialysis patient. Eye 2007;21(1):129-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16732206" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lapeyraque AL, Haddad E, André JL, Brédmon-Gignac D, et al. Sudden blindness caused by anterior ischemic optic neuropathy in 5 children on continuous peritoneal dialysis. Am J Kidney Dis 2003;42:3-9." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kim JS, Deputy S, Vives MT, Avilés DH. Sudden blindness in a child with endstage renal disease. Pediatr Nephrol 2004;19(6):691-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15052465" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Korzets A, Marashek I, Schwartz A, Rosenblatt I, Herman M, Ori Y. Ischemic Optic Neuropathy in Dialyzed Patients: A Previously Unrecognized Manifestation of" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Calcific Uremic Arteriolopathy. Am J Kidney Dis 2004;44:E93-E97. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15558514" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Briley DP, Coull BM, Goodnight SH. Neurological disease associated with antiphospholipid antibodies. Ann Neurol 1989;25:221-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2729912" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Asherson RA, Merry P, Acheson JF, Harris EN, Hughes GR. Antiphospholipid antibodies: a risk factor for occlusive ocular vascular disease in systemic lupus erythematosus and the «primary» antiphospholipid syndrome. Ann Rheum Dis 1989;48:358-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2637678" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000002900000006/v0_201502091611/X201325140903351X/v0_201502091612/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000006/v0_201502091611/X201325140903351X/v0_201502091612/en/P-E-S-A459-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325140903351X?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 16 | 23 |
| 2024 October | 41 | 37 | 78 |
| 2024 September | 65 | 23 | 88 |
| 2024 August | 86 | 48 | 134 |
| 2024 July | 51 | 25 | 76 |
| 2024 June | 65 | 32 | 97 |
| 2024 May | 63 | 32 | 95 |
| 2024 April | 56 | 17 | 73 |
| 2024 March | 37 | 27 | 64 |
| 2024 February | 37 | 35 | 72 |
| 2024 January | 38 | 26 | 64 |
| 2023 December | 19 | 19 | 38 |
| 2023 November | 34 | 30 | 64 |
| 2023 October | 40 | 18 | 58 |
| 2023 September | 27 | 26 | 53 |
| 2023 August | 52 | 37 | 89 |
| 2023 July | 34 | 31 | 65 |
| 2023 June | 23 | 19 | 42 |
| 2023 May | 44 | 37 | 81 |
| 2023 April | 22 | 29 | 51 |
| 2023 March | 29 | 24 | 53 |
| 2023 February | 30 | 18 | 48 |
| 2023 January | 28 | 11 | 39 |
| 2022 December | 41 | 34 | 75 |
| 2022 November | 36 | 17 | 53 |
| 2022 October | 34 | 35 | 69 |
| 2022 September | 43 | 32 | 75 |
| 2022 August | 37 | 43 | 80 |
| 2022 July | 31 | 36 | 67 |
| 2022 June | 27 | 23 | 50 |
| 2022 May | 35 | 29 | 64 |
| 2022 April | 64 | 38 | 102 |
| 2022 March | 60 | 28 | 88 |
| 2022 February | 62 | 36 | 98 |
| 2022 January | 60 | 35 | 95 |
| 2021 December | 42 | 35 | 77 |
| 2021 November | 34 | 42 | 76 |
| 2021 October | 42 | 43 | 85 |
| 2021 September | 46 | 32 | 78 |
| 2021 August | 37 | 29 | 66 |
| 2021 July | 38 | 30 | 68 |
| 2021 June | 32 | 22 | 54 |
| 2021 May | 43 | 25 | 68 |
| 2021 April | 50 | 22 | 72 |
| 2021 March | 53 | 11 | 64 |
| 2021 February | 54 | 18 | 72 |
| 2021 January | 35 | 17 | 52 |
| 2020 December | 31 | 9 | 40 |
| 2020 November | 39 | 11 | 50 |
| 2020 October | 20 | 8 | 28 |
| 2020 September | 15 | 7 | 22 |
| 2020 August | 28 | 9 | 37 |
| 2020 July | 39 | 7 | 46 |
| 2020 June | 25 | 7 | 32 |
| 2020 May | 47 | 10 | 57 |
| 2020 April | 26 | 12 | 38 |
| 2020 March | 34 | 7 | 41 |
| 2020 February | 26 | 18 | 44 |
| 2020 January | 40 | 16 | 56 |
| 2019 December | 39 | 15 | 54 |
| 2019 November | 27 | 24 | 51 |
| 2019 October | 22 | 8 | 30 |
| 2019 September | 30 | 14 | 44 |
| 2019 August | 14 | 16 | 30 |
| 2019 July | 27 | 20 | 47 |
| 2019 June | 35 | 17 | 52 |
| 2019 May | 31 | 14 | 45 |
| 2019 April | 52 | 37 | 89 |
| 2019 March | 30 | 14 | 44 |
| 2019 February | 16 | 11 | 27 |
| 2019 January | 24 | 16 | 40 |
| 2018 December | 65 | 36 | 101 |
| 2018 November | 51 | 9 | 60 |
| 2018 October | 61 | 11 | 72 |
| 2018 September | 52 | 15 | 67 |
| 2018 August | 32 | 12 | 44 |
| 2018 July | 50 | 12 | 62 |
| 2018 June | 48 | 20 | 68 |
| 2018 May | 40 | 10 | 50 |
| 2018 April | 45 | 5 | 50 |
| 2018 March | 46 | 6 | 52 |
| 2018 February | 39 | 2 | 41 |
| 2018 January | 36 | 4 | 40 |
| 2017 December | 31 | 9 | 40 |
| 2017 November | 16 | 5 | 21 |
| 2017 October | 30 | 9 | 39 |
| 2017 September | 24 | 8 | 32 |
| 2017 August | 35 | 6 | 41 |
| 2017 July | 26 | 11 | 37 |
| 2017 June | 26 | 13 | 39 |
| 2017 May | 24 | 17 | 41 |
| 2017 April | 20 | 10 | 30 |
| 2017 March | 21 | 30 | 51 |
| 2017 February | 15 | 10 | 25 |
| 2017 January | 16 | 5 | 21 |
| 2016 December | 57 | 9 | 66 |
| 2016 November | 57 | 6 | 63 |
| 2016 October | 124 | 12 | 136 |
| 2016 September | 153 | 6 | 159 |
| 2016 August | 216 | 3 | 219 |
| 2016 July | 180 | 8 | 188 |
| 2016 June | 122 | 0 | 122 |
| 2016 May | 113 | 0 | 113 |
| 2016 April | 89 | 0 | 89 |
| 2016 March | 68 | 0 | 68 |
| 2016 February | 79 | 0 | 79 |
| 2016 January | 112 | 0 | 112 |
| 2015 December | 95 | 0 | 95 |
| 2015 November | 79 | 0 | 79 |
| 2015 October | 73 | 0 | 73 |
| 2015 September | 75 | 0 | 75 |
| 2015 August | 59 | 0 | 59 |
| 2015 July | 46 | 0 | 46 |
| 2015 June | 30 | 0 | 30 |
| 2015 May | 54 | 0 | 54 |
| 2015 April | 6 | 0 | 6 |
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