Kumar Kshitiz, Balasubramaniam Santosh, Raj Pallavi, Agarwal Amar
Vitreo-Retina, Disha Eye Hospital, Kolkata, IND.
Vitreo-Retina, Dr. Agarwal's Eye Hospital (Kolkata Branch at Peerless Hospital & B K Roy Research Centre), Kolkata, IND.
Cureus. 2021 Apr 28;13(4):e14739. doi: 10.7759/cureus.14739.
Introduction Ocular fluid dynamics are known to improve during hemodialysis, and the improvement of uremia after dialysis may lead to osmotic pressure changes in the retina, which eventually affect retinal edema. Recent studies using optical coherence tomography (OCT) to assess the effect of hemodialysis on macular thickness have shown variable results with a majority of them finding a decrease in retinal thickness. Paradoxical neurosensory retinal detachment (NSD) may be defined as the accumulation of subretinal fluid under the macula in patients who are on continuous HD. The purpose of the study was to find out the incidence of paradoxical neurosensory detachment in diabetic eyes undergoing hemodialysis (HD) and its management. Methods This was a cross-sectional, prospective study involving end-stage renal disease (ESRD) patients secondary to diabetes. This study evaluated the changes in macular thickness in diabetic retinopathy patients with and without diabetic macular edema (DME) by spectral-domain optical coherence tomography (SD-OCT) 60 minutes before and after HD for ESRD. Results Sixty-three eyes (36 patients) were included, with a mean age of 58.2±9.8 years. Seven eyes had paradoxical NSD at presentation with an incidence of 11.11%. Eyes with DME (Group A) showed a significant reduction in central macular thickness (CMT) by 28±2μm post HD, compared to eyes without DME (Group B) where CMT decreased by 15±2μm (p=0.003). Massive subretinal fluid accumulation (paradoxical NSD) with mean CMT 675.57±69.41μm recovered to 250.71±46.79μm at the final follow-up. Five eyes underwent an intravitreal dexamethasone implant (DEX-I, Ozurdex; Allergan, Dublin, Ireland) to achieve the resolution of SRF, whereas two eyes improved spontaneously by nine months. Conclusion Hemodialysis results in a decrease of macular thickness in diabetic eyes with or without DME. Paradoxical neurosensory detachment can develop in eyes of patients undergoing HD chronically. Intravitreal dexamethasone implant (DEX-I, Ozurdex; Allergan, Dublin, Ireland) results in early amelioration of such a complication.
引言 已知血液透析期间眼内流体动力学有所改善，透析后尿毒症的改善可能导致视网膜渗透压变化，最终影响视网膜水肿。最近使用光学相干断层扫描（OCT）评估血液透析对黄斑厚度影响的研究结果不一，大多数研究发现视网膜厚度减小。矛盾性神经感觉性视网膜脱离（NSD）可定义为接受持续血液透析的患者黄斑下视网膜下液的积聚。本研究的目的是找出接受血液透析（HD）的糖尿病患者中矛盾性神经感觉性脱离的发生率及其处理方法。
方法 这是一项横断面前瞻性研究，纳入继发于糖尿病的终末期肾病（ESRD）患者。本研究通过光谱域光学相干断层扫描（SD-OCT）评估ESRD患者血液透析前后60分钟时伴有和不伴有糖尿病性黄斑水肿（DME）的糖尿病视网膜病变患者黄斑厚度的变化。
结果 纳入63只眼（36例患者），平均年龄58.2±9.8岁。7只眼在就诊时存在矛盾性NSD，发生率为11.11%。伴有DME的眼（A组）血液透析后中心黄斑厚度（CMT）显著降低28±2μm，而不伴有DME的眼（B组）CMT降低15±2μm（p=0.003）。平均CMT为675.57±69.41μm的大量视网膜下液积聚（矛盾性NSD）在最终随访时恢复至250.71±46.79μm。5只眼接受玻璃体内地塞米松植入（DEX-I，Ozurdex；爱尔兰都柏林的Allergan公司）以实现视网膜下液的消退，而2只眼在9个月时自发改善。
结论 血液透析导致伴有或不伴有DME的糖尿病患者黄斑厚度减小。长期接受血液透析的患者眼中可发生矛盾性神经感觉性脱离。玻璃体内地塞米松植入（DEX-I，Ozurdex；爱尔兰都柏林的Allergan公司）可使这种并发症早期得到改善。
