Serous retinal detachment in patients with kidney disease and on dialysis
End-stage renal disease, ESRD or kidney disease, is a severe form of chronic kidney disease that poses a large public health problem worldwide. As these patients require dialysis or even kidney transplantation because there is a poor prognosis for them medically. The incidence of patients with ESRD on dialysis is continuing to increase in both the Western and the Asian populations, and hence the association between ESRD and many retinal diseases is also increasing. The retinal diseases in question include retinal artery occlusion, retinal vein occlusion, age-related macular degeneration and serous retinal detachment.
What is serous retinal detachment?
Serous retinal detachment is a lifting up part of the retina with fluid underneath when the neurosensory retina has separated itself from the deeper layers called the pigment epithelium and results in visual impairment or loss. In turn, the retinal pigment epithelium, which is one of the deep layers of the retina, separates off as well from a deeper layer called the Bruch’s membrane of the choroid and which can give an acute visual disturbance and loss of vision. It is like wall paper blistering.
It is the initial retinal pigment epithelial detachment which can cause the development of the subsequent serous retinal detachment. It is more of a subretinal fluid leak known medically as a subretinal exudation (the wall paper blisters). Although the actual mechanics of it are not fully understood, it includes increased choroidal vascular permeability (leakage) and perfusion, together with some destabilisation of retinal epithelium and increased choroidal interstitial fluid extending into the subretinal fluid space.
The causes of serous retinal detachment are several and include renal disease, but not exclusively so. There can be an infection, collagen vascular diseases and malignancies which also can cause a serious retinal detachment.
I read an article today about serous retinal detachment and wanted to share this with you. Although it only affects what may be seen like a small proportion of the population who are having haemodialysis for kidney disease, it points out that haemodialysis is an important cause of this retinal disease.
It seems that the association of having ESRD whilst on dialysis and serous retinal detachment is now not only well recognised but increasing. If you or one of your family suffer from kidney disease and are on dialysis, then your nephrologist should be aware that there is a link between the dialysis and the increased incidence of chronic inflammation in the retina and vascular injury which can lead to serous retinal detachment. The nephrologist should ask the ophthalmologist to have a look at their renal dialysis patients, particularly if they comment on a change in their vision including reduction of vision either slowly or acutely.
If in doubt, we would be pleased, at Clinica London, to examine your retina or your relative’s retina if they are on dialysis, in order to reassure them that everything is alright or show them that there is some swelling appearing which their nephrologist needs to know about before it becomes irreversible. Mr Jaheed Khan and Professor Michel Michaelides are the Medical Retinal Experts at Clinica London.