Author(s)

Nashaat Shawky Zaky¹, Eman Gamal Megahed¹, Sherein Mahmoud Hagras¹, Abd Elmonaem Abo Elfetoh Elhesy¹, Ahmed Mohamed Naguib Attiya², Salwa Mahmoud Elwasif², Mohamed Abdul Kader Sobh³, Adel Elsayed Ellayeh¹

¹Ophthalmology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
²Nephrology Department, Mansoura Urology and Nephrology Center, Mansoura, Egypt.
³Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Background: Conventional hemodialysis (HD) used in treating end stage renal disease (ESRD) can result in multiorgan insult including the eye-owing to the resultant reperfusion after the ischemic event. Optimization of HD can be done using a process called remote ischemia which includes applying cycles of brief, nonlethal ischemia followed by reperfusion to one limb. This method sends signal to the end organs to prepare themselves for the upcoming ischemia thus preventing their injury. Aim: To evaluate the effect of remote ischemia preconditioning in HD on ophthalmological variables. Patients and Methods: A pre-post interventional analytical study conducted on patients receiving hemodialysis. Remote ischemia preconditioning was done before each HD session incorporating 3 cycles of alternating ischemia and reperfusion (5 minutes each) performed in the upper limb using sphygmomanometer cuff. Ophthalmic examination was done at baseline and 3 months after HD optimization. Assessment was done half to one hour pre- and post-session for visual acuity, corneal, conjunctival deposits, tear break up time (TBUT), anterior chamber depth and central macular thickness. Results: The study included 50 eyes of 25 patients with almost equal gender distribution and mean age of 37.52 ± 9.824 years. They were maintained on hemodialysis for median 10 years (range 3-25 years). The commonest cause of ESRD was hypertension. The studied ocular parameters showed insignificant change after pre-conditioned HD except for TBUT that was statistically longer (p = 0.018). Conclusion: Optimization of hemodialysis using remote ischemia does not seem to have significant ocular effect apart from prolonged TBUT.

Hemodialysis, Optimization, Tear Break Up Time, Ophthalmology

Shawky Zaky, N. , Gamal Megahed, E. , Mahmoud Hagras, S. , Abo Elfetoh Elhesy, A. , Naguib Attiya, A. , Mahmoud Elwasif, S. , Abdul Kader Sobh, M. and Elsayed Ellayeh, A. (2023) Effect of Optimization of Hemodialysis on Ophthalmological Variables in Patients with End Stage Renal Disease. Open Journal of Ophthalmology, 13, 398-406. doi: 10.4236/ojoph.2023.134037.