Bilateral macular infarction secondary to haemodialysis in a patient with chronic renal failure

Improved management of patients who have end-stage renal disease and are dependent on haemodialysis (HD) have resulted in increased life expectancy. Patients with chronic renal failure and renal replacement therapy can have vision loss either due to primary disease as diabetic retinopathy and hypertension or secondary to complications associated with dialysis. HD can cause ocular vascular diseases such as ischaemic optic neuropathy and retinal vein occlusion which cause severe visual loss in patients with end-stage renal disease. However, no case of macular infarction post-HD has been reported to date. A 70-year-old man presented with sudden painless loss of vision in both eyes for 1 day. There was no history of trauma or other symptoms suggestive of cerebrovascular event. Systemically he was a known case of chronic renal insufficiency secondary to hypertension and was on renal replacement therapy for the last 6 months twice a week. He had undergone HD 1 day before and complaint of loss of vision immediately after the procedure. The patient was on erythropoietin and antihypertensive medication. There was no history of diabetes or any other systemic abnormality as coronary artery disease and cerebrovascular accident. The patient had visual acuity of finger counting close to face both eyes with projection of light present in all quadrants. On ophthalmological evaluation, anterior segment was normal with no evidence of neovascularization of iris. There was no evidence of disc oedema. There was grade II hypertensive retinopathy with arteriovenous ratio of 1:3 and arteriovenous crossing changes. Veins were not dilated and non-tortuous. There were scattered retinal haemorrhages without exudation at the posterior pole. However, macula appeared pale in both eyes with surrounding retinal opacification (Fig. 1a,b).