PMID- 34079684
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210605
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 13
IP  - 4
DP  - 2021 Apr 28
TI  - Incidence of Paradoxical Neurosensory Detachment in Diabetic Eyes Undergoing 
      Hemodialysis for End-Stage Renal Disease.
PG  - e14739
LID - 10.7759/cureus.14739 [doi]
LID - e14739
AB  - Introduction Ocular fluid dynamics are known to improve during hemodialysis, and 
      the improvement of uremia after dialysis may lead to osmotic pressure changes in 
      the retina, which eventually affect retinal edema. Recent studies using optical 
      coherence tomography (OCT) to assess the effect of hemodialysis on macular 
      thickness have shown variable results with a majority of them finding a decrease 
      in retinal thickness. Paradoxical neurosensory retinal detachment (NSD) may be 
      defined as the accumulation of subretinal fluid under the macula in patients who 
      are on continuous HD. The purpose of the study was to find out the incidence 
      of paradoxical neurosensory detachment in diabetic eyes undergoing hemodialysis 
      (HD) and its management. Methods This was a cross-sectional, prospective study 
      involving end-stage renal disease (ESRD) patients secondary to diabetes. This 
      study evaluated the changes in macular thickness in diabetic retinopathy patients 
      with and without diabetic macular edema (DME) by spectral-domain optical 
      coherence tomography (SD-OCT) 60 minutes before and after HD for ESRD. Results 
      Sixty-three eyes (36 patients) were included, with a mean age of 58.2+/-9.8 years. 
      Seven eyes had paradoxical NSD at presentation with an incidence of 11.11%. Eyes 
      with DME (Group A) showed a significant reduction in central macular thickness 
      (CMT) by 28+/-2mum post HD, compared to eyes without DME (Group B) where CMT 
      decreased by 15+/-2mum (p=0.003). Massive subretinal fluid accumulation (paradoxical 
      NSD) with mean CMT 675.57+/-69.41mum recovered to 250.71+/-46.79mum at the final 
      follow-up. Five eyes underwent an intravitreal dexamethasone implant (DEX-I, 
      Ozurdex; Allergan, Dublin, Ireland) to achieve the resolution of SRF, whereas two 
      eyes improved spontaneously by nine months. Conclusion Hemodialysis results in a 
      decrease of macular thickness in diabetic eyes with or without DME. Paradoxical 
      neurosensory detachment can develop in eyes of patients undergoing HD 
      chronically. Intravitreal dexamethasone implant (DEX-I, Ozurdex; Allergan, 
      Dublin, Ireland) results in early amelioration of such a complication.
CI  - Copyright (c) 2021, Kumar et al.
FAU - Kumar, Kshitiz
AU  - Kumar K
AD  - Vitreo-Retina, Disha Eye Hospital, Kolkata, IND.
FAU - Balasubramaniam, Santosh
AU  - Balasubramaniam S
AD  - Vitreo-Retina, Dr. Agarwal's Eye Hospital (Kolkata Branch at Peerless Hospital & 
      B K Roy Research Centre), Kolkata, IND.
FAU - Raj, Pallavi
AU  - Raj P
AD  - Anterior Segment & Glaucoma, Sankar Nethralaya, Kolkata, IND.
FAU - Agarwal, Amar
AU  - Agarwal A
AD  - Anterior Segment & Cataract, Dr. Agarwal's Eye Hospital (Kolkata Branch at 
      Peerless Hospital & B K Roy Research Centre), Kolkata, IND.
LA  - eng
PT  - Journal Article
DEP - 20210428
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC8162472
OTO - NOTNLM
OT  - central macular thickness
OT  - dexamethasone implant
OT  - diabetic macular edema
OT  - hemodialysis
OT  - paradoxical neurosensory detachment
COIS- The authors have declared that no competing interests exist.
EDAT- 2021/06/04 06:00
MHDA- 2021/06/04 06:01
PMCR- 2021/04/28
CRDT- 2021/06/03 06:42
PHST- 2021/06/03 06:42 [entrez]
PHST- 2021/06/04 06:00 [pubmed]
PHST- 2021/06/04 06:01 [medline]
PHST- 2021/04/28 00:00 [pmc-release]
AID - 10.7759/cureus.14739 [doi]
PST - epublish
SO  - Cureus. 2021 Apr 28;13(4):e14739. doi: 10.7759/cureus.14739.