[Anterior ischemic optic neuropathy in children]

A 5-year old girl with history of chronic renal failure due to dysplastic and polycystic kidney disease treated with peritoneal dialysis since birth wake up the the day after an scheduled uncomplicated peritoneal dialysis except for asymptomatic arterial hypotension with bilateral blindness. Neurological examination was normal except for absent light perception and tracking of optokinetic tape, dilated (7 mm) and unresponsive to light pupils, pale and slighted elevated disks with blurred margins and pale retina with irregular abnormal appearing vessels. Spinal fluid examination revealed no abnormalities except for slight pleocytosis (12 WBC, 68% mononuclears and 32% lymphocytes). MRI with gadollinium and MRA were normal. She received intravenous methyprednisolone for 3 days and intravenous and intraperitoneal antibiotics and intravenous acyclovir without improvement. She also received topical dorsolamide hydrochloride. Two year later she remained blind without light perception. Final diagnosis was anterior ischemic optic neuropathy. Pathogenesis, clinical picture, differential diagnosis and treatment of this condition in children are discussed.