Surgical management of hemodialysis patients

Ophthalmic surgeons can expect increased opportunities in the future to treat patients who undergo maintenance hemodialysis. Such patients often present with complex medical problems and carry high risk factors for surgery. Nevertheless, the full range of ophthalmic surgical procedures can be accomplished without increased morbidity when patient management is carefully organized between the ophthalmologist and nephrologist. In this report the physiology of the functionally anephric patient is reviewed. Attention is directed to the most commonly encountered complications: systemic hypertension, uremia, electrolyte imbalance, drug toxicity, and arteriovenous fistula thrombosis. Specific guidelines are then presented to reduce the risk of complications at each phase of hospitalization.