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| CASE REPORT |
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| Year : 1987 | Volume
: 35
| Issue : 2 | Page : 82-83 |
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Haemodialysis cataract
SK Angra, JL Goyal
RP. Centre for Ophthalmic Sciences, ALLMS., Ansari Nagar, New Delhi-110 029, India
Correspondence Address:
S K Angra
RP. Centre for Ophthalmic Sciences, ALLMS., Ansari Nagar, New Delhi-110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 3450624 
A rare case of bilateral osmotic cataract following repeated haemodialysis is being reported. Possible mechanism of the process of cataractogenesis is discussed
How to cite this article:
Angra S K, Goyal J L. Haemodialysis cataract. Indian J Ophthalmol 1987;35:82-3 |
| Introduction | |  |
Haemodialysis is routinely done in patients with chronic renal failure but development of cataract following haemodialysis is rare [1],[2]. A case of chronic renal failure which rapidly developed bilateral osmotic cataract following haemodialysis is being reported in this communication.
| Case report | | |
A39 year old female presented to us with a rapidly progressive deterioration of vision in both eyes following haemodialysis for the last 11/2 months The patient was an old case of Nephrotic Syndrome for 13 years and had developed chronic renal failure since the last 3 years Haemodialysis was started bi-weekly 1 1/2 month back. she complained of rapidly progressive deterioration of vision in both eyes following a second dialysis The repeated haemodialysis were being continued.
On general physical examination the patient was hypertensive, BP. - 170/100 mm. Hg, which was controlled with antihypertensive drugs There was mild anaemia but no oedema of feet Otherwise the cardiac, respiratory and central nervous systems were normal. On local examination visual acuity in both eyes was perception of light with accurate projection of light in all quadrants In the anterior segment both the eyes revealed bilateral swollen cataractous [Figure - 1] lenses causing shallow anterior chambers Intra ocular pressure was normal in both eyes No glow could be seen on fundus examination.
The posterior segment on electrophysiological and ultrasonographic investigations was normal in both eyes. The medical records did not reveal any lenticular opacity prior to the onset of the present complaints.
The range of pre and post dialysis biochemical profiles were as follows
Serum calcium level remained between 8.10 mgm % (normal value 9-11.5 mgm %). This was marginally low and there were no tetanic spasms The diabetic state was excluded by G.T.T. The patient was operated for cataract in both eyes at an interval of 12 weeks and she regained a vision of 6/9 in both eyes. The post operative period was uneventful Fundus seen post operatively was normal revealing no haemorrhages or exudates
| Discussion | | |
In chronic renal failure ocular features like retinal oedema, cotton wool exudates, retinal haemorrhages, disc oedema, arteriosclerosis, metastatic calcification of the conjunctiva and cornea [3] have been described, but occurence of cataract is rare [1],[2]. Berlyne et al [2] have reported that in 50% of the cases of chronic renal failure the crystalline lenses showed punctate cataracts similar to those seen in hypocalceamic states In these patients the serum calcium was less than 6 mg %. They believed it to be due to hypocalcemia in chronic renal failure But our case here, showed almost normal calcium levels and does not seem to be the likely cause for cataractogenesis.
Haemodialysis is commonly done to lower the blood urea levels Amongst its ocular complications central retinal vein occlusion [4], raised intraocular pressure [5] and retinal haemorrhages [6] have been described. Occurence of bilateral osmotic cataract following haemodialysis is rare. Avello [7] described rapid progression of the lenticular opacities due to renal dialysis in a case of acute renal failure. Our case had renal.. failure for the last 3 years without diminution of vision and lenticular changes The pathology started after haemodialysis which led to complete cataract formation in a short period of one and half months An upset of serum osmolarity due to low calcium and high potassium has been thought to be the causative factor by Mautner [8]. We would like to support Orth et al [9] who believe that this cataract is due to the urea disequilibrium because in our case calcium and pottasium levels were only marginally deranged and should not lead to formation of cataract In renal failure due to raised blood urea, urea enters into the lens After dialysis, the aqueous urea level comes rapidly in equilibrium with the blood serum level, but the turnover of urea from the lens is very slow, leading to retention of urea inside the lens, thus creating an osmotic disequilibrium To maintain the osmotic balance, water is imbibed from the aqueous into the lens leading to swelling of the lens This re adjustment process takes time Repeated haemodialysis causes imbalance again and again, thus the urea level in the lens remain high, accumulating more and more water inside the lens This process continues and ultimately ends up in a total osmotic cataract.
| References | | |
| 1. | Duke Elder, S., 1969, System of Ophthalmology, Vo. X, p. 210, Henry Kimpton, London.  |
| 2. | Borlyne LM., Ben Ari J., Danovetch G.M. & Blumenthal M, 1962, Lancet 509 (1). |
| 3. | Maselli E, di Mauro Z, Locateli F, Pincella G, 1969, AttL Soc. Offal Lombarda, 24, 167. |
| 4. | Pratt Ill. E, De Venecin G,1970, Am. J. Ophthalmol, 70, 337. |
| 5. | Appelmans M, Demouchamps J. P., De Wolf J., Dralands L, 1967, Soc Belge, Ophthalmol, 147, 426. |
| 6. | Koch H.R., Sideck M., Metzler U., 1972, Klin Monatsbl Augenheilkd, 160, 353. |
| 7. | Avello J., 1983, Arch. Soc. OftaL Hisp., Amer. 23,817. |
| 8. | Mautner W., 1972, Klin Monatsbl, Augenheilkd, 160, 350. |
| 9. | Orth J., Koch H. R, Klehr H.V., Siedeck M, 1978, Interdiscip, Trop. Gerontol, 13, 109-118. |
[Figure - 1]
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