Study associates dialysis procedure with sudden optic neuropathy in children

Sudden onset of blindness in five children seems to have resulted from a regimen of continuous peritoneal dialysis, according to a recent report. Hypovolemia was highly suspected as the cause of ischemic optic neuropathy in all cases, the authors of the report said.

Anne-Laure Lapeyraque, MD, and colleagues in France, England and the United States, reported these five cases in the American Journal of Kidney Disease. In addition to ischemic optic neuropathy, edema and hemorrhages were also noted in these patients.

Because of the poor prognosis for ischemic optic neuropathy, the diagnosis and treatment of hypovolemia in children on continuous peritoneal dialysis is essential, the authors said.

According to the report, the patients had a mean age of 32 months (range 11 to 60). At initial clinical evaluation, all children had loss of light perception, visual fixation and ocular pursuit. All children also had bilateral mydriasis that was unreactive to bright light.

One child was dehydrated, but the other four were not; however, all patients had blood pressures below normal range. Because of this, hypovolemia was suspected to be the cause of the neuropathy in all patients.

Four patients were treated with steroids, three received anticoagulation or antiagregation drugs, two received plasma or macromolecule infusions, two received vasodilators, and one patient underwent transient dialysis interruption.

One child with hepatic cirrhosis died 4 days later due to acute liver insufficiency caused by ischemic hepatic necrosis. The remaining children had only partial improvement in vision during the following months, the authors wrote.