Tratamiento ciclodestructivo para la elevación sintomática de la presión intraocular durante la hemodiálisis: reporte de dos casos y revisión de la literatura

Abstract

Introduction

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

Methods

We conducted a search across PubMed and Epistemonikos databases constructing a theoretical framework based on primary studies and similar case reports. Additionally, 2 cases of patients with CKD and severe ocular pain during HD are presented from data from electronic health records, including demographic data, clinical presentations, treatments, and post-treatment outcomes.

Results

Both patients received cyclodestructive treatment for episodes of symptomatic hypertensive glaucoma during HD, showing favorable clinical outcomes after treatment controlling IOP surges and relieving ocular pain during the HD sessions.

Discussion

This review sheds light on a relatively underexplored aspect of glaucoma treatment in CKD patients on HD, in whom cyclodiode laser therapy seems to be a promising option in cases where visual acuity cannot be recovered. However, since evidence is still emerging, future prospective comparative studies are needed to provide further information to regulate routine clinical practice.