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Abstract
Purpose
To investigate the changes of visual acuity and central macular thickness (CMT) in patients with diabetic retinopathy (DR) receiving long-term hemodialysis (HD).
Methods
From January 1, 2008, to December 31, 2018, the medical records of patients who were diagnosed with DR receiving HD three times a week for ≥18 months due to chronic kidney disease (CKD) were analyzed. Among them, patients diagnosed with DR 6 months before the start of HD were included. Patients with vitreous hemorrhage (VH) affecting visual acuity (VA), other retinal diseases, and cataract surgery after HD were excluded. The VA and CMT before HD and at 1, 3, 6, 12, and 18 months after HD were analyzed.
Results
Of the 222 eyes of 111 patients who were diagnosed with DR and received HD for CKD due to diabetes, 174 eyes with DR diagnosed after starting HD were excluded. Ten eyes with VH before starting HD, two eyes with epiretinal membrane, and four eyes with cataract surgery after starting HD were also excluded. Thirty-two eyes of 18 patients were included. The mean age of the patients was 53.71 ± 9.25 years. Twenty-four males and eight female patients were included in the study. The mean logMAR VA improved significantly from 0.36 ± 0.28 before starting HD to 0.26 ± 0.27 at 18 months after starting HD (p = 0.002). The mean CMT was significantly decreased from 307.12 ± 89.52 µm before starting HD to 279.71 ± 61.75 µm at 12 months after starting HD (p = 0.02).
Figures and Tables
Figure 1
Long term changes of best corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) before hemodialysis (HD), 1 month, 3 months, 6 months, 12 months, and 18 months after HD. (A) BCVA improved significantly at 18 months after HD compared with before HD. (B) CMT decreased significantly at 3, 12, 18 months after HD compared with before HD. (C) IOP did not show statistically significantly difference at 18 months after HD compared with before HD.
*p<0.05.
Figure 2
The representative case of changes in spectral domain optical coherence tomography (SD-OCT) findings before and after hemodialysis (HD). A 47-year-old man with diabetic chronic kidney disease who was diagnosed with diabetes retinopathy 3 years previously before HD. He received intravitreal bevacizumab injection for the right eye due to diabetic macular edema three times before HD and twice after HD. (A) SD-OCT shows severe macular edema in his right eye before HD. (B) SD-OCT shows significantly reduced macular edema in his right eye at 18 months after HD.
Table 1
Clinical characteristics of included patients
Values are presented as mean ± standard deviation or number (%) unless otherwise indicated.
HD = hemodialysis; DM = diabetes mellitus; DR = diabetic retinopathy; NPDR = non proliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy; HTN = hypertension; BUN = blood urea nitrogen; GFR = glomerular filtration rate; VEGF = vascular endothelial growth factor; STTA = subtenon triamcinolone acetonide; VH = vitreous hemorrhage.
*p = 0.185; †p = 0.136; ‡p = 0.447, determined using the paired t-test.
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