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Sudden blindness caused by anterior ischemic optic neuropathy in 5 children on continuous peritoneal dialysis

Anne-Laure Lapeyraque1, Elie Haddad, Jean-Luc André

  • 1Service de Néphrologie and the Service d'Ophtalmologie, Hopital Robert Debré, Assistance Publique-Hopitaux de Paris, Paris, France.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|October 29, 2003
PubMed

Insights

Sudden blindness in children undergoing continuous peritoneal dialysis may signal hypovolemia. Prompt diagnosis and management of low blood volume are crucial to prevent permanent vision loss.

Area of Science:

  • Ophthalmology
  • Nephrology
  • Pediatrics

Background:

  • Continuous peritoneal dialysis (CPD) is a vital treatment for pediatric end-stage renal disease.
  • Potential complications of CPD, particularly those affecting vision, require thorough investigation.

Observation:

  • Five children undergoing CPD experienced sudden, severe vision loss.
  • Clinical presentation included loss of light perception, unreactive pupils, and fundoscopic signs of anterior ischemic optic neuropathy.
  • Hypovolemia, indicated by low blood pressure, was suspected in all cases, despite varying hydration states.

Findings:

  • The primary cause of sudden blindness in these pediatric CPD patients was likely hypovolemia-induced anterior ischemic optic neuropathy.
  • Treatment modalities varied, including steroids, anticoagulation, fluid resuscitation, and dialysis adjustments, with limited visual recovery observed.
  • One patient with hepatic cirrhosis developed ischemic hepatic necrosis and died.

Implications:

  • This study highlights the critical need for vigilant monitoring of hydration status and blood pressure in children on CPD.
  • Early detection and management of hypovolemia are essential to prevent irreversible vision loss and other severe complications.
  • Further research into the pathophysiology and preventative strategies for hypovolemia-related optic neuropathy in pediatric CPD patients is warranted.

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