A complex case of haemodialysis induced increased intraocular pressure

Purpose: To describe a case of intraocular pressure fluctuation during haemodialysis in a patient with previously treated proliferative diabetic retinopathy and previous unilateral angle neovascularisation. Case description: A 63-year-old male with end-stage renal disease on maintenance haemodialysis and recurrent episodes of symptomatic intraocular pressure rise during dialysis sessions. Higher intraocular pressure spikes occurred in the eye with previous angle new vessels. Outcome: Topical antihypertensive drops failed to control the intraocular pressure. Due to multiple co-morbidities, options of medical management were deemed unsuitable; those included intravenous mannitol, systemic acetazolamide and intravenous glucose. Furthermore, modifications of his dialysis prescription did not lead to satisfactory results. As a consequence, the patient underwent trabeculectomy with mitomycin C. Adequate control of his intraocular pressure was achieved post-operatively. Conclusion: Intraocular pressure fluctuations during haemodialysis are not fully understood, and management can be quite challenging to the treating ophthalmologists and nephrologists. In this case report, we discuss some of those difficulties and different treatment options.