Improvement in open-angle glaucoma by nocturnal home haemodialysis.

Open-angle glaucoma (OAG) is a common ocular abnormality seen in patients with end-stage renal disease (ESRD) [1]. Although the pathogenesis of OAG is not yet fully understood, lowering intraocular pressure is the accepted treatment goal. Without adequate treatment, glaucoma can lead to visual disability and eventual blindness [2]. From a simplified viewpoint, intraocular pressure is determined by the balance between aqueous production from the ciliary body and drainage of the aqueous humour through the trabecular meshwork. Normal intraocular pressure (IOP) ranges from 10 to 21mmHg. IOP of 20–30mmHg usually results in chronic optic nerve damage. In cases of significant intraocular hypertension (40–50mmHg), rapid visual loss and retinovascular occlusion may occur. Intradialytic alteration of IOP by conventional haemodialysis (CHD) has been well-documented [3,4]. It is generally accepted that there are two opposing forces, which may impact on IOP during haemodialysis: ultrafiltration and solute removal. Tokuyama et al. [3] documented a fall in IOP which was inversely correlated with the increase in plasma oncotic pressure caused by ultrafiltration. In contrast, other authors speculated that the rapid removal of uraemic toxins via CHD may lower plasma osmolality at a rate in excess of changes in ocular osmolality resulting in an acute rise in IOP [5]. Nocturnal haemodialysis (NHD), which provides 8–10 h of renal replacement therapy during sleep, 5–7 nights per week, is a form of intensive haemodialysis which approximates most closely to normal physiology [6]. Here, we report our index case in which the conversion from CHD to NHD is associated with a restoration in IOP. We will further examine the potential interactions between augmentation of uraemia clearance, enhanced volume control and changes in total peripheral resistance in the treatment of glaucoma with NHD in ESRD patients.