Visual function can be preserved in insulin-dependent diabetic patients treated by maintenance haemodialysis

Evolution of visual function was assessed in 43 insulin-dependent diabetic (IDD) patients treated by maintenance haemodialysis (MH) for a cumulative duration of 1248 patient-months. At start of MH, 23 patients (46 eyes) still had good vision, 20 patients (40 eyes) were blind. All 40 blind eyes had severe proliferative retinopathy (PR) with additional irreversible complications in 32. Of the 46 eyes with preserved vision, PR was present in 24 (52.2%) with only 2 additional severe complications. Restoration of sight was obtained either spontaneously or after ophthalmic surgery in 6 eyes (7%). Stabilisation was achieved in 74% of eyes which retained vision at the start of MH. Two patients with eyesight at start of MH became blind (8.7%). Aggravation of visual function is mainly related to development of PR and not to haemodialysis per se. Careful ophthalmic follow-up, together with close control of diabetes, blood-pressure and uraemia can ensure preservation of vision in most IDD patients treated by MH.