Cyclodestructive treatment for symptomatic intraocular pressure elevation during hemodialysis: case reports and literature review.

Abstract

Introduction: Within the characteristics of hypertensive glaucoma, it is distinguished by presenting elevated intraocular pressure (IOP) associated with a low ocular perfusion pressure (OPP). Changes in these parameters can be affected by systemic disease such chronic kidney disease (CKD). Likewise, there is a correlation in the prevalence of both pathologies in patients with similar characteristics, emphasizing the need to address glaucoma management in patients with CKD given the implications of the disease on ocular pathology. Furthermore, hemodialysis (HD) is the maintenance treatment for end-stage CKD, which can lead to transient increases in IOP contributing to ocular discomfort and potential glaucoma progression.

Methods: A search was conducted in PubMed and Epistemonikos databases, constructing a theoretical framework based on primary studies and similar case reports. Additionally, two cases of patients with CKD with severe ocular pain during HD are presented, compiling data from electronic medical records, including demographic data, clinical presentations, treatments, and post-treatment outcomes.

Results: Both patients received cyclodestructive treatment for symptomatic hypertensive glaucoma episodes during HD, showing favourable clinical outcomes after treatment, both in controlling IOP elevation and relieving ocular pain during hemodialysis sessions.

Discussion: This review sheds light on a relatively underexplored aspect of glaucoma treatment in CKD patients on HD, where cyclodiode laser therapy appears to be a promising option in cases where there is no recoverable visual acuity. However, since the evidence is still emerging, future prospective comparative studies are needed to provide further information to clinical practice.