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Bilateral retinal detachment - when the kidney meets the eye / Descolamento de retina bilateral - quando o rim afeta o olho
Henriques, Susana; Lima, Anna; Almeida, Júlio; Basto, Rita; Roque, Joana; Coutinho, Inês; Prieto, Isabel.
  • Henriques, Susana; Hospital Professor Doutor Fernando Fonseca. Ophthalmology Department. PT
  • Lima, Anna; Hospital Professor Doutor Fernando Fonseca. Nephrology Department. PT
  • Almeida, Júlio; Hospital Professor Doutor Fernando Fonseca. Ophthalmology Department. PT
  • Basto, Rita; Hospital Professor Doutor Fernando Fonseca. Ophthalmology Department. PT
  • Roque, Joana; Hospital Professor Doutor Fernando Fonseca. Ophthalmology Department. PT
  • Coutinho, Inês; Hospital Professor Doutor Fernando Fonseca. Ophthalmology Department. PT
  • Prieto, Isabel; Hospital Professor Doutor Fernando Fonseca. Ophthalmology Department. PT
Rev. bras. oftalmol ; 80(5): e0045, 2021. graf
Article in English | LILACS | ID: biblio-1347259
ABSTRACT
ABSTRACT Exudative retinal detachment occurs when fluid accumulates between the neurosensory retina and the retinal pigment epithelium. Ocular diseases or multisystem conditions such as nephrotic syndrome may lead to exudative retinal detachment. This report describes a case of nephrotic syndrome secondary to minimal change disease, anasarca and bilateral serous macular detachment in an adult patient. A 75-year-old male patient presented to the emergency department with generalized edema, asthenia, and visual impairment. Medical history included a recent diagnosis of nephrotic syndrome secondary to minimal change disease, which had been controlled with corticosteroid therapy. At presentation, best corrected visual acuity was 20/100. Slit-lamp examination revealed xanthelasmas and mild bilateral eyelid edema and chemosis. Dilated fundus examination confirmed bilateral macular detachment. The patient did not respond to diuretic therapy. Ttherefore, hemodialysis was started. Two months later, visual acuity improved to 20/25 and near normal restoration of retinal anatomy was achieved, with concurrent remission of proteinuria. Exudative retinal detachment is a multifactorial condition. However, in diseases associated with severe hypoalbuminemia, such as nephrotic syndrome, low oncotic pressure in choroidal vessels and high interstitial pressure in the choroid may explain retinal detachment. Patients with chronic kidney disease carry a high risk of ophthalmic disease development. Several mechanisms that affect ocular vessels, the retina and the choroid are thought to be involved. A multidisciplinary approach is crucial to resolve the ophthalmic condition and improve overall health.
RESUMO
RESUMO O descolamento de retina exsudativo ocorre quando o fluido se acumula entre a retina neurossensorial e o epitélio pigmentado da retina. Patologias oculares isoladas ou doenças multissistêmicas, como a síndrome nefrótica, podem levar ao descolamento de retina exsudativo. Apresenta-se aqui o caso de um adulto com síndrome nefrótica por doença de lesões mínimas, anasarca e descolamento de retina exsudativo macular bilateral. Trata-se de um homem de 75 anos de idade, que recorreu ao serviço de urgência com edema generalizado, astenia e diminuição da acuidade visual. Os antecedentes pessoais incluíam diagnóstico recente de síndrome nefrótica secundária à doença de lesões mínimas, em uso de corticoterapia. Na apresentação, a melhor acuidade visual corrigida era 20/100. A biomicroscopia revelou xantelasmas, edema palpebral leve e quemose nos dois olhos. Fundoscopia mostrou descolamento macular bilateral. O doente iniciou diuréticos com pouca resposta clínica, tendo sido adicionada hemodiálise. Verificou-se melhora da acuidade visual para 20/25 e restauração quase total da anatomia da retina 2 meses após o início do tratamento, coincidindo com a remissão da proteinúria. A fisiopatologia dos descolamentos de retina exsudativos é multifatorial, mas, em doenças com hipoalbuminemia grave, como a síndrome nefrótica, a baixa pressão oncótica e a alta pressão intersticial na coroide podem explicar o descolamento macular exsudativo. Doentes com doença renal crônica constituem um grupo de risco para o desenvolvimento de doença ocular, envolvendo vários mecanismos que afetam vasos, retina e coroide. Uma abordagem multidisciplinar é crucial para a melhoria da doença oftalmológica e do estado geral do doente.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Retinal Detachment / Renal Insufficiency, Chronic / Nephrotic Syndrome Type of study: Diagnostic study Limits: Aged / Humans / Male Language: English Journal: Rev. bras. oftalmol Journal subject: Ophthalmology Year: 2021 Type: Article Affiliation country: Portugal Institution/Affiliation country: Hospital Professor Doutor Fernando Fonseca/PT

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Full text: Available Index: LILACS (Americas) Main subject: Retinal Detachment / Renal Insufficiency, Chronic / Nephrotic Syndrome Type of study: Diagnostic study Limits: Aged / Humans / Male Language: English Journal: Rev. bras. oftalmol Journal subject: Ophthalmology Year: 2021 Type: Article Affiliation country: Portugal Institution/Affiliation country: Hospital Professor Doutor Fernando Fonseca/PT