2023 Volume 56 Issue 11 Pages 443-447
The patient was a 68-year-old woman. She was diagnosed with hypertension at around the age of 40. At about age 50, she showed a decline in her renal function, with the level of serum creatinine at 1.2 mg/dL. Her renal function gradually worsened, and she was referred to our hospital at age 66 for peritoneal dialysis as renal replacement therapy. She was diagnosed with bilateral neovascular glaucoma at age 67 and underwent trabeculectomy of the left eye at age 68. Due to visual impairment, management of her peritoneal dialysis became difficult and blood cleaning efficiency decreased, leading to hospitalization for hybrid dialysis. Low-efficiency hemodialysis using glycerol was started to prevent intraocular pressure elevation. The patient presented with pain in her right eye two hours later, and alcohol blocks were performed in the ophthalmology department to control her intraocular pressure. The right eye pain improved and hemodialysis was performed again, but the right eye pain recurred the same as before. We determined that the patient could not continue hemodialysis. During peritoneal dialysis, no pain occurred in her right eye. Glaucoma attacks became apparent during hemodialysis, suggesting that intraocular pressure elevations during hemodialysis can be caused by the same mechanism as in imbalance syndrome. We present our experience whereby peritoneal dialysis could be safely performed for a glaucoma patient with poorly controlled intraocular pressure as renal replacement therapy.
