A Case of Acute Nonarteritic Anterior Ischemic Optic Neuropathy in Patient on Hemodialysis

Ae Young Kwak; Gyu Ah Kim; Jung Bum Choi

doi:10.3341/jkos.2013.54.12.1960

Journal List > J Korean Ophthalmol Soc > v.54(12) > 1009578

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Kwak, Kim, and Choi: A Case of Acute Nonarteritic Anterior Ischemic Optic Neuropathy in Patient on Hemodialysis

Original Article

J Korean Ophthalmol Soc 2013;54(12):1960-1965.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.12.1960

A Case of Acute Nonarteritic Anterior Ischemic Optic Neuropathy in Patient on Hemodialysis

Ae Young Kwak, MD^1,², Gyu Ah Kim, MD^1,², Jung Bum Choi, MD^2,

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

²Siloam Eye Hospital, Seoul, Korea

Address reprint requests to Jung Bum Choi, MD Siloam Eye Hospital, #181 Deungchon-ro, Gangseo-gu, Seoul 157-836, Korea, Tel: 82-2-2650-0880, Fax: 82-2-2650-0895, E-mail: jb-choi@hanmail.net

Received 25 August 201213 May 2013 Accepted 1 October 2013

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 non-arteritic anterior ischemic optic neuropathy (NAION) in a patient on hemodialysis.

Case summary

A 59-year-old female undergoing intravenous hemodialysis developed sudden blurred vision for 2 days. Chronic hypotension and anemia may have been persisted for approximately 6 months before the onset of symptoms. Her corrected visual acuity in both eyes was 0.7 and visual field test showed superior arcuate defect in the left eye. Fundus photography showed inferonasal optic disc swelling and fluorescein angiography revealed hyperfluorescence of the disc in the late phase which was probably attributable to NAION. After 3 weeks, corrected visual acuity was 0.7 in the left eye and fundoscopic finding of the left eye was improved.

Conclusions

Hemodialysis can cause a hypotensive event and anemia which may be associated with NAION. Avoiding acute hypotension and anemia should be advised to prevent development of NAION in dialysis patients.

Keywords: Anemia, Hemodialysis, Hypotension, Non-arteritic anterior ischemic optic neuropathy

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Figure 1.

Humphrey visual field test shows arcuate defect at superior field of the left eye.

Figure 2.

(Left) At the first visit, fundus photograph revealed optic disc swelling of the inferonasal optic nerve head in the left eye. (Right) Fundus photograph shows decreased optic disc swelling in the left eye after 3 weeks.

Figure 3.

Fundus fluorescein angiography shows hyperfluorescence of the optic disc at the late phase.

Table 1.

The comparison of characteristics in previously reported hemodialysis-associated AION cases

Author	Laterality of AION	Systemic Hx.	Ocular Hx.	Age/Sex	Type of dialysis	Visual Prognosis
Servilla et al.¹¹ (1986)	Bilateral	HTN	None	30/male	HD	Not examined
Michaelson et al.³² (1989)	Bilateral	Hypotension	Optic disc drusen	23/female	PD	Not improved
Hamed et al.¹² (1989)	Unilateral	HTN, Anemia	None	41/female	HD	Slightly improved
Haider et al.⁸ (1993)	Unilateral	DM, Hypotension, Anemia	None	53/male	HD	Not examined
	Unilateral	HTN, Anemia	None	42/female	HD	Not improved
	Unilateral	HTN, CHF, Gout, Anemia	None	77/female	PD	Not examined
	Unilateral	DM, CAOD, PAOD	PDR with PRP	32/male	HD	Partially improved
Connolly et al.¹³ (1994)	Unilateral	HTN, Anemia	None	39/male	HD	Slightly improved
	Bilateral	Hypotension	PDR with PRP	26/female	HD	Slightly improved
Sabeel et al.²⁵ (1998)	Bilateral	GCA, Autonomic neuropathy	None	40/female	HD	Not improved
Jackson et al.³³ (1999)	Bilateral	Hypotension	None	58/male	PD	Not improved
Basile et al.¹⁶ (2001)	Bilateral	Hypotension	None	49/male	HD	Not improved
Chutorian et al.³⁴ (2002)	Bilateral	Hypotension	None	5/female	PD	Not improved
	Bilateral	None	None	2/male	PD	Not improved
Korzet et al.¹⁴ (2004)	Unilateral	Hypotension, CAOD, Calcific uremic arteriopathy	None	77/male	HD	Not examined
	Unilateral	IgG monoclonal gammopathy, AMI	Cataract surgery	70/female	HD	Not improved
Neito et al.¹⁰ (2010)	Bilateral	Hypotension, Anemia	None	26/male	HD	Not improved
	Bilateral	Hypotension	None	56/male	PD	Not improved
Kwak et al. (this report)	Unilateral	Hypotension, Anemia	Cataract surgery		HD	Not improved

HTN = hypertension; DM = diabetic mellitus; CHF = congestive heart failure; CAOD = coronary artery occlusive disease; PAOD = peripheral artery occlusive disease; GCA = giant cell arteritis; AMI = acute myocadiac infarction; IgG = immunoglobulin G; PDR = proliferative diabetic retinopathy; PRP = panretinal laser photocoagulation; HD = hemodialysis; PD = peritoneal dialysis.

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