CORRELATION OF OCULAR PERFUSION PRESSURE AND INTRAOCULAR PRESSURE CHANGES DURING HEMODIALYSIS IN END-STAGE RENAL DISEASE: AN OBSERVATIONAL STUDY
Abstract
BACKGROUND: Patients with chronic kidney disease who get hemodialysis experience a brief increase in intraocular pressure and a drop in ocular perfusion pressure. This helps in the early diagnosis of optic nerve damage from glaucoma and that results in irreversible loss of vision.
OBJECTIVE: This observational study aims to investigate the correlation between OPP and IOP changes during hemodialysis in patients with ESRD
MATERIALS AND METHODS: The observational study enrolled 60 adult patients diagnosed with ESRD undergoing regular hemodialysis at Saveetha Medical College & Hospital, Chennai. Patients with a history of ocular diseases (e.g., glaucoma, uveitis) or ocular surgeries were excluded from the study. Before the initiation of hemodialysis, baseline measurements of BP, MAP, IOP & OPP were obtained using standard techniques. BP was recorded as the average of three consecutive measurements taken using an automated sphygmomanometer. IOP was measured using a Schiotz tonometer. During hemodialysis, BP was monitored continuously and additional BP measurements were obtained at 2-hour intervals. IOP measurements were repeated at the same time points.
RESULTS: Mean IOP from the initiation to the end of hemodialysis was found to be increased and the mean arterial pressure and ocular perfusion pressure were found to be decreased from the initiation to the end of hemodialysis. At the end of study period, mean arterial pressure (MAP) from the initiation to the end of hemodialysis was found to be decreased by 89 mm Hg. It was found to be statistically significant (p- value: 0.001). Ocular perfusion pressure from the initiation to the end of hemodialysis was found to be decreased by 67.2 mm Hg in both eyes. It was found to be statistically significant (p-value 0.001). Intraocular pressure ocular perfusion pressure from the initiation to the end of hemodialysis was found to be decreased by 21.8 mm Hg in both eyes. It was found to be statistically significant (p-value 0.001).
CONCLUSION: Our study reveals the importance of screening and monitoring of intraocular pressure and characteristic early optic nerve head changes and early visual field changes of glaucoma in end-stage renal disease patients who are on hemodialysis. Variations in ocular perfusion pressure due to IOP and BP fluctuations may play a role in glaucoma development or progression. Hence monitoring of intraocular pressure and screening for early optic nerve head changes and early visual field defects is mandatory in end-stage renal disease patients on hemodialysis.
