gms | German Medical Science

Marked changes in the osmolarity of the serum as well as other body-fluids, e. g. due to diabetes, cholera or haemodialysis, may result in fluid shifts, also intumescence of the lens with consecutive cataract. Reports on the influence of dialysis on intraocular pressure are inconsistent. We report the case of a patient suffering from primary open-angle glaucoma who experienced recurrent elevations of intraocular pressure during dialysis.

In addition to basic examination we measured intraocular pressure by applanation, gained topometric data using the Orbscan II and took photographs of changes visible by means of the slit-lamp microscope both before and directly after dialysis.

Because of the documented rise in intraocular pressure during dialysis the patient had undergone YAG-laser iridotomies in both eyes as well as surgical iridectomy in his left eye before he was referred to us. Although they were found to be open we measured a rise in intraocular pressure of 10 to 12 mmHg directly after dialysis. While the lens showed swelling the anterior chamber became shallow especially in its periphery. Within six hours both intraocular pressure and the clinical findings of the anterior segment returned to normal without having to supplement the medical treatment for glaucoma.

An intumescence of the lens caused by decrease of serum osmolarity during dialysis may lead to an angle block either by pupillary or by ciliary block. In this case the cause of a pupillary block is to be excluded because of the open iridectomy. The ciliary block may end when the lens swelling will regress.