Anterior ischemic optic neuropathy in pediatric peritoneal dialysis: risk factors and therapy.
BACKGROUND
Sudden blindness caused by anterior ischemic optic neuropathy (AION) is a rare complication for patients undergoing peritoneal dialysis (PD). Prognosis is generally poor, with AION commonly resulting in permanent visual loss.


METHODS
We first describe four case reports of children with AION during PD treatment. We then review ten additional AION cases reported in the literature and compare these 14 affected patients with a control cohort of 59 non-affected patients in the Vienna PD registry.


RESULTS
Significant risk factors for AION were identified as median age (4 vs. 27 months; p < 0.001), autosomal recessive polycystic kidney disease (28.6 vs. 3.4%; p = 0.01), anephric status (53.8 vs. 6.8%; p < 0.001) and low to normal blood pressure evidenced by the number of patients having to be treated with antihypertensive medications (14.3 vs. 62.7%; p = 0.01). Severe hypovolemia was reported in 50% of all cases. Outcome was visual loss with optic atrophy in nine patients; five patients had a good visual outcome. The major difference in treatment was a rapid bolus of saline within 12 h after the initial symptoms.


CONCLUSIONS
Young age, autosomal recessive polycystic kidney disease, anephric status and hypotension are substantial risk factors for AION. Early hospitalization with vascular refilling within a few hours following onset of blindness leads to improved visual outcome.
Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Stephanie
S
Dufek
Markus
M
Feldkoetter
Enrico
E
Vidal
Mieczyslaw
M
Litwin
Marion
M
Munk
Andreas
A
Reitner
Thomas
T
Mueller-Sacherer
Christoph
C
Aufricht
Klaus
K
Arbeiter
Michael
M
Boehm
D000293:Adolescent; D000367:Age Factors; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications; D007223:Infant; D008297:Male; D018917:Optic Neuropathy, Ischemic / Q000209:etiology* / Q000628:therapy; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D017044:Polycystic Kidney, Autosomal Recessive / Q000150:complications; D012307:Risk Factors