Jornal de Oftalmologia Clínica e Experimental
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Alteration in Retinal Thickness and Perfusion after Haemodialysis Assessed by Optical Coherence Tomography Angiography

Hong Liang Lin, Shuang Xin Liu, Yu Qiao Zhang, Chun Xin Lai, Jin Xian Xie, Wen Juan Xie, Bei Ting He, Yu-Lin Zhang, Yong Jie Qin, Hong Yang Zhang

Importance: Hemodialysis is one of the most common renal replacement therapies but regularly causes microcirculatory change. Measuring retinal microcirculation may be the way to evaluate the adverse effect of hemodialysis.

Background: To evaluate the effects of hemodialysis on the microcirculation perfusion in End-Stage Renal Disease (ESRD) patients through observation of the alteration of peripapillary and macular perfusion by Optical Coherence Tomography Angiography (OCTA).

Design: A retrospective study.

Participants: A total of 37 patients (19 ESRD patients and 18 age-matched healthy individuals) were enrolled in this study.

Methods: All 19 ESRD patients underwent ocular assessments 1 hour before, 1 hour and 24 hours after hemodialysis, while18 healthy individuals underwent OCTA measurement twice with four hours interval. Vascular vessel density of optic disc and macular region, peripapillary Retinal Nerve Fiber Layer (RNFL) and retinal thickness were measured by OCTA.

Main outcome measures: Retinal vascular vessel density and thickness.

Results: Increase in peripapillary RNFL thickness along with decrease in peripapillary vessel density was found at 1h after hemodialysis. Increase in peripapillary RNFL thickness last for at least 24 hours after hemodialysis, while decrease in peripapillary vessel density diminished after 24 hours. We also found significant increase in deep capillary plexus which recovered after 24 hours. Retinal thickness is also increased after hemodialysis.

Conclusion: Hemodialysis induced transient decrease in peripapillary perfusion and mild RNFL edema, which may cause transient damage of retina. OCTA may be an ideal method to evaluate the alteration of retinal vascular system and a potential parameter for microcirculatory perfusion in hemodialysis patients.