Pallid Disc Edema and Choroidal Perfusion Delay in Post-Hemodialysis Non-Arteritic Ischemic Optic Neuropathy

Non-arteritic anterior ischemic optic neuropathy (NAION) is a rare but recognized ophthalmic complication in patients with end-stage renal disease (ESRD) on chronic hemodialysis characterized by unilateral or bilateral acute visual loss. Anemia, concomitant vaculopathic risk factors (i.e. diabetes, atherosclerosis), autonomic dysfunction and the hypotensive effect of hemodialysis are among the predisposing factors to the development of ischemic optic neuropathy (ION) in this patient population. Although pallid disc edema, cotton wool spots, and a choroidal perfusion delay have been classically associated with giant cell arteritis (GCA). We reported two cases of NAION in patients with ESRD on chronic hemodialysis who demonstrated pallid disc edema in conjunction with choroidal and retinal ischemia. To our knowledge, this is the first such report in the English language ophthalmic literature.