Abstract

P 162

Bilateral nonarteriitic anterior ischemic optic neuropathy (NAION) under recombinant human erythropoietin therapy

Melanie Jäger, Frank Weinand
Klinik und Poliklinik für Augenheilkunde, Standort Gießen, Universitätsklinikum Gießen und Marburg GmbH, Gießen

Objective
Treatment with recombinant human erythropoietin is standard in dialysis patients to prevent renal anemia. Aim of this case report is to emphasize ocular side effects of polyglobuly.
Results
We describe the case of a 50-year-old woman on dialysis for many years. She complained of progressive bilateral blurred vision for several days (RE 0.5, LE 0.3). Funduscopic examination showed asymmetric bilateral optic nerve swelling in addition to unspecific visual field defects. Because of a history of lymphoma cerebral computer tomography was performed disclosing cerebral microangiopathy and some postischemic lesions. The hemoglobin content was 15.3 g/l, and the hematocrite 44%. The patient developed a relative afferent pupillary defect LE and the visual field defects increased. After consequent lowering of the hemoglobin level from 15.3 to 12 g/l by discontinuing the erythropoietin therapy the findings improved. Two months after first presentation an optic nerve head atrophy was diagnosed. At the last visit visual acuity was 0.6 RE and 0.5 LE, and the visual field defects were stable.
Conclusions
In addition to renal anemia and arterial hypotension an increased hemoglobin level appears to be a risk factor for NAION in long-term hemodialysis patients with erythropoietin therapy. Therefore in dialysis patients with signs of vascular compromise in the fundus, controlling the hemodynamic balance may be recommended.

Copyright: 2009 Porstmann Kongresse GmbH. All rights reserved. Impressum, Disclaimer.