Posterior Segment changes of eyes in Diabetic patients undergoing Hemodialysis: An Observational study

Abstract

Background:
Renal and retinal circulations share similar anatomic, physiologic and pathologic features; hence evaluating the retinal microvasculature can help identify early microcirculatory changes associated with Chronic kidney disease (CKD). In End-stage renal disease (ESRD) visual system is affected as a result of uraemia, metabolic imbalance, hypertension or hemodialysis (HD). One of the major risk factor for ESDR is Diabetes mellitus (DM), and it’s prevalence has increased in India. Diabetic retinopathy (DR) and nephropathy are two frequent complications of DM and they add burden of CKD and blindness respectively. Objectives of the study were to assess the posterior segment status of eye and severity of diabetic retinopathy in diabetics undergoing hemodialysis.
Methods:
Observational cross-sectional study was conducted in the Nephrology Unit at a tertiary care hospital and included 120 diabetics undergoing hemodialysis twice weekly. Ocular examination included visual acuity using Snellen’s chart, Intra ocular pressure (IOP) using applanation tonometry and posterior segment evaluation after dilating with tropicamide and phenylephrine.
Results:
Mean age of diabetic patients undergoing dialysis was 55.77 years with SD of 9.42. 65% of the patients were known to be diabetic for duration of less than 5 years. Moderate NPDR (37.91%) constituted the major group, followed by mild NPDR (23.33%) and severe NPDR (18.33%).76 eyes (31.66%) showed clinically significant macular edema (CSME). Association between diabetic retinopathy severity and duration of DM was found to be significant (P value = 0.028). Association of duration of hemodialysis and severity of DR was also significant (P value = 0.037).
Conclusions:
Moderate NPDR is the most common retinopathy in patients undergoing hemodialysis. Significant association was noted between duration of DM and severity of DR and between duration of HD and severity of DR. It is important for patients with diabetic ESRD to undergo ophthalmological evaluation regularly prior to the development of irreversible vision loss.