Posterior ischemic optic neuropathy following continuous renal replacement therapy: a case report

Area of Science:

• Ophthalmology
• Nephrology
• Intensive Care Medicine

Background:

• Posterior ischemic optic neuropathy (PION) is an uncommon cause of acute vision loss in intensive care unit (ICU) patients.
• PION following continuous renal replacement therapy (CRRT) has not been previously reported.
• This report details a case of bilateral nonarteritic PION after initiating CRRT.

Purpose of the Study:

• To report the first known case of nonarteritic PION following CRRT initiation.
• To emphasize the importance of considering PION in ICU patients with sudden vision loss and vascular risk factors during CRRT.

Main Methods:

• A 52-year-old male with hypertension and stage 4 CKD received CRRT for metabolic acidosis and hyperkalemia.
• Following CRRT initiation, the patient experienced sudden, bilateral, painless vision loss.
• Diagnostic workup included ophthalmological examination, MRI/MRA, and assessment for giant cell arteritis; high-dose corticosteroids were administered without effect.

Main Results:

• The patient presented with complete vision loss in both eyes after CRRT initiation.
• Ophthalmological and neurological imaging revealed no abnormalities, but MRA showed bilateral carotid and right MCA stenosis.
• The diagnosis of nonarteritic PION was established due to the clinical presentation and exclusion of other causes.

Conclusions:

• PION should be suspected in patients with vascular risk factors experiencing sudden, painless vision loss post-CRRT initiation, even without optic disk edema.
• Maintaining stable blood pressure during CRRT initiation is crucial for preventing PION in at-risk individuals.
• This case underscores a novel association between CRRT and PION, necessitating vigilance in ICU settings.