Uremic Optic Neuropathy in Chronic Renal Failure

Ji Min Lee; Samin Hong; Chan Yun Kim; Gong Je Seong

doi:10.3341/jkos.2016.57.7.1187

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Lee, Hong, Kim, and Seong: Uremic Optic Neuropathy in Chronic Renal Failure

Case Report

J Korean Ophthalmol Soc 2016;57(7):1187-1191.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.7.1187

Uremic Optic Neuropathy in Chronic Renal Failure

Ji Min Lee, MD¹, Samin Hong, MD, PhD^1,^2,^3,, Chan Yun Kim, MD, PhD¹, Gong Je Seong, MD, PhD¹

¹The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

²Hong Samin Optic Nerve Regeneration and Stem Cell Research Institute, Seoul, Korea

³Hong Samin Yonsei Eye Clinic, Seoul, Korea

Address reprint requests to Samin Hong, MD, PhD Department of Ophthalmology, Severance Hospital, #50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: 82-2-2228-3570, Fax: 82-2-312-0541 E-mail: samini@yuhs.ac

Received 26 November 2015 Accepted 5 April 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of uremic optic neuropathy occurring in a patient with chronic renal failure.

Case summary: A 40-year-old male who was diagnosed with chronic renal failure and treated with peritoneal dialysis and hemodialysis for 17 years presented with blurred vision and a moving pain in his left eye for 2 days. The best corrected visual acuity (BCVA) was 0.2 in his left eye, and an inferior altitudinal visual field defect was noted on Humphrey perimetry. Fundus examination and optical coherence tomography showed optic disc swelling in his left eye; the right eye was unremarkable. These findings were compatible with a diagnosis of uremic optic neuropathy or anterior ischemic optic neuropathy of his left eye. After treatment of hemodialysis and intravenous high dose steroid pulse therapy, the BCVA in his left eye was 0.8. However, since he refused oral steroid maintenance therapy, his BCVA later decreased to 0.4. After treatment with subtenon triamcinolone injection, the BCVA in his left eye was 1.0 and showed a stable disease course.

Conclusions

When patient with chronic renal failure presents with acute decrease in visual acuity and visual field defect, optic neuropathies including uremic optic neuropathy should be considered and prompt hemodialysis and systemic steroid treatment should be done.

Keywords: Hemodialysis, Uremia, Uremic optic neuropathy

References

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Figure 1.

Optical coherence tomography at the first visit. Optical coherence tomography showed optic disc swelling in the left eye. ONH = optic nerve head; RNFL = retinal nerve fiber layer; OU = oculus unitas; OD = oculus dexter; OS = oculus sinister; C/D = cup-to-disc ratio; TEMP = temporal; SUP = superior; NAS = nasal; INF = inferior; S = superior; N = nasal; I = inferior; T = temporal.

Figure 2.

Fundus photographs at the first visit. These show no specific sign on the right eye (A) and optic disc swelling on the left eye (B).

Figure 3.

The patient's visual field tests at the first visit. Humphrey visual field test showed an altitudinal visual field defect at inferior field of the left eye. POS = positive; NEG = negative; SITA = Swedish interactive threshold algorithm; RX = prescription; DS =dioptres sphere; DC = dioptres cylinder; GHT = glaucoma hemifield test; VFI = visual field index; MD = mean deviation; PSD = pattern standard deviation.

Figure 4.

Fundus photograph (A) and optical coherence tomography (B) of the patient after treatment. These show decreased optic disc swelling at the left eye after treatment. ONH = optic nerve head; RNFL = retinal nerve fiber layer; OU = oculus unitas; OD = oculus dexter; OS = oculus sinister; C/D = cup-to-disc ratio; TEMP = temporal; SUP = superior; NAS = nasal; INF = inferior; S = superior; N = nasal; I = inferior; T = temporal.

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