Prevalence of optic nerve edema in patients on peripheral hemodialysis.
OBJECTIVE
Cerebral venous hypertension with optic nerve edema has been reported in patients with peripheral arteriovenous hemodialysis shunts. This study aimed to estimate the prevalence of optic nerve edema in patients with peripheral arteriovenous accesses and to evaluate the value of ophthalmic examination and surveillance in this study population.


METHODS
Cross-sectional observation case series.


METHODS
Forty-four patients with peripheral arteriovenous shunts for hemodialysis.


METHODS
A cross-sectional observation was done of all patients with peripheral arteriovenous shunts presenting to our outpatient hemodialysis unit on 2 consecutive days. Using indirect ophthalmoscopy, the presence or absence of optic nerve edema was recorded. Patients also were asked to record any symptoms suggestive of intracranial hypertension and/or papilledema such as headache, decreased visual acuity, or an abnormal visual phenomenon. The 95% confidence interval (CI) was calculated to estimate the prevalence of optic nerve edema in patients with peripheral arteriovenous accesses. A literature search also was conducted to obtain prior reports of optic nerve edema and ophthalmic complications in patients with peripheral arteriovenous accesses.


METHODS
Presence or absence of optic nerve edema.


RESULTS
Among our series of 44 patients with peripheral arteriovenous shunts for hemodialysis, no case of optic nerve edema was observed and no patient reported any headache, decrease in vision, or visual phenomenon. The 95% CI for the estimated prevalence of optic nerve edema was 0% to 8.0%. A literature review revealed 7 reports of symptomatic ophthalmic complications in patients with peripheral arteriovenous accesses.


CONCLUSIONS
Although cases of papilledema in patients with peripheral arteriovenous shunts have been reported in the literature, the occurrence appears to be low, and routine ophthalmic surveillance is probably unnecessary in asymptomatic patients.
Taban
Mehran
M
Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Taban
Mehryar
M
Lee
Michael S
MS
Smith
Scott D
SD
Heyka
Robert
R
Kosmorsky
Gregory S
GS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000453:epidemiology / Q000209:etiology; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D010211:Papilledema / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects / Q000706:statistics & numerical data*