Sudden blindness in a child with end-stage renal disease

Continuous peritoneal dialysis (CPD) is the preferred modality for renal replacement therapy in children with end-stage renal disease. Anterior ischemic optic neuropathy (AION) is a rare complication in patients on CPD. AION is characterized by ischemic injury of the optic nerve caused by hypoperfusion of the posterior ciliary arteries. It presents with acute visual loss and disc swelling, without additional neurological findings. We report a 2-year-old child with end-stage renal disease on CPD who developed AION. He was dehydrated and received intravenous fluid on admission. Additional treatment included methylprednisolone and levodopa. On his 3rd admission day, his pupils became reactive to light and his vision showed improvement. The improvement in vision might be due to the early detection and aggressive treatment of hypotension. It is difficult to demonstrate whether steroids or levodopa played a role in the improvement of his vision. Prospective studies to evaluate the effectiveness of levodopa in the treatment of AION are warranted in this potentially devastating condition.