Maja Ayodele K, Lewis Chad Y, Steffen Eric, Zegans Michael E, Graber Martha L
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Kidney Med. 2022 Aug 1;4(9):100526. doi: 10.1016/j.xkme.2022.100526. eCollection 2022 Sep.
A man in his early 70s presented with a 1-month history of headache, left-sided photophobia, periorbital pain, and redness occurring during hemodialysis. He had a history of ESKD secondary to diabetic nephropathy and of proliferative diabetic retinopathy. We observed elevated intraocular pressure during dialysis. A diagnosis of neovascular glaucoma with a compromised iridocorneal angle was made. Medical management of glaucoma and modifications to the hemodialysis regimen were initiated but were insufficient. The resolution of symptoms required surgical management, including cataract extraction with intraocular lens placement, pars plana vitrectomy, and peripheral retina endolaser, and placement of an Ahmed glaucoma drainage valve. This case illustrates the importance of attention to intraocular pressure and risk factors for glaucoma in patients treated with hemodialysis. Clinicians caring for patients treated by hemodialysis should consider hemodialysis-related elevation in intraocular pressure as a possible etiology for headache, visual changes, or ocular symptoms during dialysis and should pursue ophthalmic evaluation.
一名70岁出头的男性患者，有1个月的头痛病史，伴有左侧畏光、眶周疼痛，且在血液透析期间出现眼红症状。他有糖尿病肾病继发终末期肾病（ESKD）病史及增殖性糖尿病视网膜病变病史。我们在透析期间观察到眼压升高。诊断为新生血管性青光眼，伴有虹膜角膜角受损。开始了青光眼的药物治疗并调整了血液透析方案，但效果不佳。症状的缓解需要手术治疗，包括白内障摘除联合人工晶状体植入、玻璃体切割术、周边视网膜激光光凝，以及植入艾哈迈德青光眼引流阀。该病例说明了在接受血液透析治疗的患者中关注眼压和青光眼危险因素的重要性。照顾接受血液透析治疗患者的临床医生应将透析相关的眼压升高视为透析期间头痛、视力变化或眼部症状的可能病因，并应寻求眼科评估。
