A Study of Intraocular Pressure During Hemodialysis in CRF Patients

ABSTRACT

PURPOSE: Hemodialysis, a treatment for patients with severely compromised renal failure, is the elimination of osmotic active substances by diffusion. Some authors have reported that change in osmorality between the serum and the aquous humor during hemodialysis increased in intraocular pressure (IOP). We investigated the change of IOP and serum osmolarity during hemodialysis and the effect of oral carbonic anhydrase inhibitor (Diamox(R)), topical carbonic anhydrase inhibitor (Trusopt(R)) and oral hypertonic solution(glycerol). METHODS: In 45 CRF patients (90 eyes) without glaucoma, IOP, serum osmorality, pH, and HCO3- were measured during hemodialysis, and oral carbonic anhydrase inhibitor (Diamox(R)), topical carbonic anhydrase inhibitor (Trusopt(R)) and oral hypertonic solution (glycerol) werw administered if IOP rose by over 6mmHg during hemodialysis. After adminitration of the agents, we checked effect of preventing IOP elevation and metabolic change during hemodialysis. RESULTS: The intraocular pressure rose above 6 mmhg in 24 eyes (24.6%) during hemodialysis. Oral carbonic anhydrase inhibitor induced more severe metabolic acidosis than topical carbonic anhydrase inhibitor but topical carbonic anhydrase inhibitor was less effective in lowering IOP. CONCLUSIONS: Because of more effective lowering of IOP and rare complications of metabolic acidosis, hypertonic solution (glycerol) was effective and safe in neovascular glaucoma and in glaucoma patients with severely damaged optic nerve.