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Elevated Intraocular Pressure Post-Hemodialysis after Simple Pars Plana Vitrectomy: A Case Report
玻璃體切除手術後的病人在洗腎後産生高眼壓的現象：病例報告
摘要
目的：洗腎後產生的暫時性高眼壓並不常見，我們在此報告一病例，闡述一位洗腎病人，在經過玻璃體切除手術後，於洗腎後產生的暫時性高眼壓變化，並描述其高眼壓的治療經過。 方法：一病例報告。 結果：觀察到一位七十二歲男性病患，在洗腎後產生的左眼暫時性高眼壓現象。而此現象在左眼接受玻璃體手術後才產生，病患在洗腎時，發現他的左眼視力變模糊，並沒有產生 心或頭痛的現象，經過以timolol與xalatan治療後，此現象仍然持續，在門診追蹤時，發現前房隅角有狹窄的情形，經過與腎臟科醫師討論後，將其透析液的流速由每分鐘750毫升減為每分鍾500毫升，經過此改變，其眼壓由55mmHg降為35mmHg，之後也改變透析液的組成，病患發現在洗腎時左眼產生的視力模糊現象也消失了。 結論：在末期腎臟病患的患者，在洗腎後産生眼壓高的現象是很少見的，有可能是因為透析液的因素。然而，假若病患接受過玻璃體切除手術且為前房隅角狹窄之患者，洗腎時，降低透析液的流速與改變透析液的組成，可以避免高眼壓的産生。
關鍵字
無資料並列摘要
Purpose: To report a case of marked elevated IOP during and post-dialysis after vitrectomy. Case: a 72 year-old man complained of transient blurred vision of left eye during hemodialysis after vitrectomy. Results: A 72 year-old male presented with marked IOP elevation of his left eye after hemodialysis. This episode did not happen before vitrectomy. Transient blurred vision was complained without headache or nausea when IOP was markedly elevated. Despite medication with timolol and xalatan, the marked IOP elevation of left eye after hemodialysis was still noted. Anterior chamber angle narrowing was found during OPD follow up postoperatively. After consulting with nephroloists, dialyhsate flow rate was shifted from 750ml/min to 500 ml/min and the acetate dialysate was replaced by a bicarbonate type. The marked IOP elevation decreased (55mmHg →35mmHg → 21mmHg). Transient blurred vision of left eye during dialysis rarely happened after dialysate parameters were changed. Conclusion: IOP elevation during or after dialysis is a rate complication in patients with ESRD in the recent years. This has been attributed to dialysate parameters and flow rate. However, if the angle is compromised, especially post-vitrectomy, transient markedly elevated IOP could occur when rapid dialysis is performed.