Change in Retinal and Choroidal Thickness after Hemodialysis in Chronic Renal Failure Patients using Swept Source Optical Coherence Tomography

Abstract

Purpose : Controversy exists regarding the changes of retinal and choroidal thickness during hemodialysis (HD) and there a few reports about these thickness changes using Swept-source optical coherence tomography (SS-OCT). We performed a prospective study to evaluate the effect of HD on the retinal and choroidal thickness in end-stage renal disease (ESRD) using SS-OCT.

Methods : 34 eyes, 34 patients with ESRD undergoing HD were recruited and analyzed. Detailed ophthalmic examinations such as intraocular pressure (IOP), axial length (AXL), anterior chamber depth (ACD) and retinal, choroidal thickness were measured immediately before and after HD. Measurement was conducted adjacent the dialysis center in order to reduce errors of time. Using SS-OCT (DRI OCT Triton®, Topcon, Tokyo), retinal and choroidal subfield mappings were measured as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS). We used a 12x9mm 3D volume scan protocol and analyzed by automated segmentation. Systemic parameters such as body weight, systolic/diastolic blood pressure were also measured. The relationships between the systemic hemodynamic changes and the ophthalmic changes during HD were evaluated. Subgroup analysis was done: 19 eyes, 19 patients with diabetic mellitus (DM) and 15 eyes, 15 patients with non-DM.

Results : In all patients, total choroidal thickness was significantly decreased after the HD (-7.0±10.4 %, p<0.001). Total choroidal thickness was significantly decreased both in DM (-6.1±5.7 %, p=0.002) and non-DM patients (-8.5±14.5 %, p=0.013). And choroidal thickness decreased more subfields in DM patients compared to non-DM patients. Retinal thickness was increased in partial subfields but total retinal thickness change was not statistically significant (p=0.086). Total retinal thickness was increased significantly only in DM patients (1.0±1.2 %, p=0.006). IOP was significantly decreased only in DM patients (-6.5±11.4 %, p=0.022) after HD. There were no significant correlation affecting factors with changes of total retinal and choroidal thickness.

Conclusions : Choroidal thickness was significantly decreased after HD in most subfields. Additionally, it was more subfields in DM patients than non-DM patients. IOP was significantly decreased after HD in DM patients. We should consider these ocular hemodynamic changes in ESRD patients with HD.