Anterior ischemic optic neuropathy and dialysis: Effect of hypotension
A 24-year-old female presented with sudden loss of vision in her left eye (OS). Her past medical history was significant for chronic renal failure secondary to chronic reflux as a child, one previous failed renal transplant and dialysis four times a week. She used to complain of severe ocular pain in both eyes (OU) during dialysis, which was attributed to repeated episodes of systemic hypotension, which aggravated ocular ischemia. Due to this she was put on home oxygen 100% 24 hours a day and this significantly improved her pain, which was felt to be coming from an ocular ischemic syndrome.\nShe was diagnosed to have left posterior ION and bilateral ocular ischemic syndrome with rubiosis iridis. She underwent pan retinal photocoagulation (PRP) and intravitreal injection of Avastin®. This had no effect on vision and the rubeosis iridis, but did reduce the new vessels in the retina. Two months later she presented with a painful right AION. She then developed a right posterior subcapsular cataract and her vision dropped to hand movements. Her cataract was removed and her vision improved to 6/60. However, one month later she developed a right recurrent ION affecting the inferior arcade and hence she lost her superior field of vision. The patient died 3 months after her cataract surgery due to complications of chronic renal failure.