Sudden blindness caused by anterior ischemic optic neuropathy in 5 children on continuous peritoneal dialysis.
The authors report the occurrence of sudden blindness in 5 children (mean age, 32 months; range, 11 to 60) during continuous peritoneal dialysis regimen. All children presented with loss of light perception, visual fixation and ocular pursuit, and bilateral mydriasis unreactive to bright light. Fundoscopic examination found signs of anterior ischemic optic neuropathy with disc swelling, edema, and hemorrhages. Whereas 1 patient was dehydrated, the 4 other patients appeared well and not dehydrated. Nevertheless, blood pressure was below the normal range in all of them. Therefore, hypovolemia is highly suspected to have been the cause of ischemic optic neuropathy in all cases. Treatment consisted of steroids (4 patients), anticoagulation or antiagregation drugs (3 patients), plasma or macromolecules infusions (2 patients), vasodilatators (2 patients), and transient dialysis interruption (1 patient). One child with hepatic cirrhosis died 4 days later of acute liver insufficiency owing to ischemic hepatic necrosis. The other children had only partial improvement of vision during the following months. Because the prognosis of ischemic optic neuropathy is very poor, diagnosis and treatment of chronic hypovolemia in children on continuous peritoneal dialysis is essential to prevent such a devastating complication.
Service de Néphrologie and the Service d'Ophtalmologie, Hopital Robert Debré, Assistance Publique-Hopitaux de Paris, Paris, France.
Anne-Laure
AL
Lapeyraque
Elie
E
Haddad
Jean-Luc
JL
André
Dominique
D
Brémond-Gignac
C Mark
CM
Taylor
Pornpimol
P
Rianthavorn
Isidro B
IB
Salusky
Chantal
C
Loirat
D001766:Blindness / Q000188:drug therapy / Q000209:etiology*; D002675:Child, Preschool; D003681:Dehydration / Q000150:complications* / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D020896:Hypovolemia / Q000150:complications* / Q000628:therapy; D007223:Infant; D008297:Male; D009392:Nephrectomy; D018917:Optic Neuropathy, Ischemic / Q000188:drug therapy / Q000209:etiology*; D010211:Papilledema / Q000209:etiology; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*