Evaluation of choroidal and retinal thickness measurements in adult hemodialysis patients using spectral-domain optical coherence tomography.

Ali Kal,Ozlem Öner,Cem Kucukerdonmez,Gürsel Yılmaz,Fatma Corak Eroglu,Oznur Kal

doi:10.5935/0004-2749.20160066

Ali Kal, Ozlem Öner + Show 4 more

Open Access

https://doi.org/10.5935/0004-2749.20160066

Copy DOI

Abstract

To assess the effect of hemodialysis on retinal and choroidal thicknesses using spectral-domain optical coherence tomography (SD-OCT). In this prospective interventional study, 25 hemodialysis patients (17 male, 8 female) were enrolled. All participants underwent high-speed, high-resolution SD-OCT (λ=840 mm; 26.000 A-scans/s; 5 µm resolution) before and after hemodialysis. Choroidal thickness was measured perpendicularly from the outer edge of the retinal pigment epithelium to the choroid-sclera boundary at the fovea and at five additional points: 500 µm and 1000 µm nasal to the fovea and 500 µm, 1000 µm, and 1500 µm temporal to the fovea. Two masked physicians performed the measurements. Choroidal and retinal thicknesses before and after hemodialysis were compared. The median choroidal thicknesses before and after hemodialysis were 182 µm (range, 103-374 µm) and 161 µm (range, 90-353 µm), respectively (P<0.001). The median retinal thicknesses were 246 µm (range, 179-296 µm) before and 248 µm (range, 141-299 µm) after hemodialysis (P>0.05). Systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate, and ocular perfusion pressure significantly decreased after hemodialysis (P<0.001). Intraocular pressure did not vary significantly (P=0.540). Hemodialysis seems to cause a significant decrease in choroidal thickness, whereas it has no effect on retinal thickness. This significant decrease in choroidal thickness might be due to the extensive fluid absorption in hemodialysis, which could result in decreased ocular blood flow.

Highlights

Hemodialysis is the diffusion of molecules in solution across a semipermeable membrane through an electrochemical concentration gradient
We investigated the changes in retinal and choroidal thicknesses before and after high-ultrafiltration-volume hemodialysis in patients with end-stage renal disease (ESRD)
Hemodialysis did not cause a significant decrease in median retinal thickness (246 μm [range, 179-296 μm] before versus 248 μm [range, 141-299 μm] after hemodialysis; [P=0.12])

Summary

Introduction

Hemodialysis is the diffusion of molecules in solution across a semipermeable membrane through an electrochemical concentration gradient. The main objective of hemodialysis is to repair the intracellular and extracellular fluid environment. This is accomplished by the transport of solutes such as urea from the blood into the dialysate and by the transport of solutes such as bicarbonate from the dialysate into the blood[1,2]. Hemodialysis is required for the survival of patients with renal failure and end-stage renal disease (ESRD) by filtering the blood, it corrects the excessive accumulation and abnormal distribution of solutes in body fluids[3]. Changes in the systemic hemodynamic and metabolic parameters associated with hemodialysis may affect ocular fluid dynamics and composition, blood vessels, tissues of the retina, the choroid, and the optic nerve[4,5,6]. Optical coherence tomography (OCT) is a noninvasive, interferometric optical imaging technique that provides high-resolution cross-sectional images of the retina using the reflectivity of light waves[9,10]

Methods

Results

Discussion

Conclusion