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Japanese Journal of Ophthalmology

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01-01-2022 | Night-Blindness | Clinical Investigation

Acquired night blindness due to rod dysfunction after long-term hemodialysis

Authors: Shinji Ueno, Satoshi Okado

Published in: Japanese Journal of Ophthalmology | Issue 1/2022

Abstract

Purpose

To report the clinical findings in 6 patients who developed night blindness after long-term hemodialysis.

Study design

Retrospective case series.

Patients and methods

The medical charts of the 6 patients were examined. The fundus photographs, spectral-domain optical coherence tomographic (SD-OCT) images, full-field ERGs, and blood chemistry panels were analyzed.

Results

The mean age of the 6 patients (4 men) at the time of diagnosis was 69.1 ± 5.9 years. The mean duration of the hemodialysis was 21.8 ± 13.4 years (7–41 years). The visual acuity of the patients was preserved at 20/30 or better except in 1 eye. Ophthalmoscopy showed white flecks that were scattered over the midperipheral retina in all the eyes. SD-OCT showed mild macular degeneration in 5 eyes. The scotopic ERGs elicited by dim flashes were absent, and those elicited by bright flashes had negative waveforms. The photopic ERGs were relatively well preserved. These data indicated a rod-specific dysfunction that may account for the night blindness. The plasma concentration of vitamin A was within the normal range in 4 of the patients and slightly lower than the normal limit in 1 of the patients. Administration of vitamin A was performed for 1 patient, and the symptom of night blindness and scotopic ERGs were improved 3 months later.

Discussion

Long-term hemodialysis can be associated with the night blindness that may be caused by vitamin A deficiency, even though the plasma concentration of vitamin A in these patients was within the normal range.

Thirkill CE, FitzGerald P, Sergott RC, Roth AM, Tyler NK, Kaltner JL. Cancer-associated retinophaty (CAR syndrome) with antibodies reacting with retinal, optic-nerve, and cancer cells. N Engl J Med. 1989;321:1589–94.CrossRef

Milam AH, Saari JC, Jacobson SG, Lubinski WP, Feun LG, Alexander KR. Autoantibodies against retinal bipolar cells in cutaneous melanoma-associated retinopathy. Invest Ophthalmol Vis Sci. 1993;34:91–100.PubMed

Ueno S, Inooka D, Nakanishi A, Okado S, Yasuda S, Kominami T, et al. Clinical course of paraneoplastic retinopathy with anti-TRPM1 autoantibody in Japanese cohort. Retina. 2019;39:2410–8.CrossRef

Tsang SH, Sharma T. Autoimmune retinopathy. Adv Exp Med Biol. 2018;1085:223–6.CrossRef

Harris EW, Loewenstein JI, Azar D. Vitamin A deficiency and its effects on the eye. Int Ophthalmol Clin. 1998;38:155–61.CrossRef

Kelsey JH, Arden GB. Acquired unilateral loss of dark adaptation. Br J Ophthalmol. 1971;55:38–43.CrossRef

Kondo M, Nakamura M, Tanikawa A, Kachi S, Hirai T, Miyake Y. Acquired unilateral night blindness with negative ERG: nine-year follow-up. Retina. 2005;25:519–21.CrossRef

Tsunoda K, Fujinami K, Yoshitake K, Iwata T. Late-onset night blindness with peripheral flecks accompanied by progressive trickle-like macular degeneration. Doc Ophthalmol. 2019;139:171–84.CrossRef

Ueno S, Inooka D, Meinert M, Ito Y, Tsunoda K, Fujinami K, et al. Three cases of acute-onset bilateral photophobia. Jpn J Ophthalmol. 2019;63:172–80.CrossRef

10.

Nishida T, Sawada A, Mochizuki K, Niwa Y, Hayakawa K. Case of acquired night blindness in a hemodialysis patient. Can J Ophthalmol. 2013;48:e148–51.CrossRef

11.

McCulloch DL, Marmor MF, Brigell MG, Hamilton R, Holder GE, Tzekov R, et al. ISCEV standard for full-field clinical electroretinography (2015 update). Doc Ophthalmol. 2015;130:1–12.CrossRef

12.

Hayashi T, Goto-Omoto S, Takeuchi T, Gekka T, Ueoka Y, Kitahara K. Compound heterozygous RDH5 mutations in familial fleck retina with night blindness. Acta Ophthalmol. 2006;84:254–8.CrossRef

13.

Spaide RF, Curcio CA. Drusen characterization with multimodal imaging. Retina. 2010;30:1441–54.CrossRef

14.

Zaharova E, Sherman J. The use of SD-OCT in the differential diagnosis of dots, spots and other white retinal lesions. Eye Brain. 2011;3:69–80.CrossRef

15.

Fukukita H, Ito Y, Iwase T, Kaneko H, Yasuda S, Kataoka K, et al. Inner macular changes after vitrectomy with internal limiting membrane peeling for rhegmatogenous retinal detachment: similarity with Alport syndrome. Retina. 2019;39:2332–40.CrossRef

16.

Hayashi T, Hosono K, Kurata K, Katagiri S, Mizobuchi K, Ueno S, et al. Coexistence of GNAT1 and ABCA4 variants associated with Nougaret-type congenital stationary night blindness and childhood-onset cone-rod dystrophy. Doc Ophthalmol. 2020;140:147–57.CrossRef

17.

Dryja TP, Hahn LB, Reboul T, Arnaud B. Missense mutation in the gene encoding the alpha subunit of rod transducin in the Nougaret form of congenital stationary night blindness. Nat Genet. 1996;13:358–60.CrossRef

18.

Dryja TP, Berson EL, Rao VR, Oprian DD. Heterozygous missense mutation in the rhodopsin gene as a cause of congenital stationary night blindness. Nat Genet. 1993;4:280–3.CrossRef

19.

Gal A, Orth U, Baehr W, Schwinger E, Rosenberg T. Heterozygous missense mutation in the rod cGMP phosphodiesterase beta-subunit gene in autosomal dominant stationary night blindness. Nat Genet. 1994;7:64–8.CrossRef

20.

Szabo V, Kreienkamp HJ, Rosenberg T, Gal A. pGln200Glu, a putative constitutively active mutant of rod alpha-transducin (GNAT1) in autosomal dominant congenital stationary night blindness. Hum Mutat. 2007;28:741–2.CrossRef

21.

Sandberg MA, Pawlyk BS, Dan J, Arnaud B, Dryja TP, Berson EL. Rod and cone function in the Nougaret form of stationary night blindness. Arch Ophthalmol. 1998;116:867–72.CrossRef

22.

Apushkin MA, Fishman GA. Improvement in visual function and fundus findings for a patient with vitamin A-deficient retinopathy. Retina. 2005;25:650–2.CrossRef

23.

Genead MA, Fishman GA, Lindeman M. Fundus white spots and acquired night blindness due to vitamin A deficiency. Doc Ophthalmol. 2009;119:229–33.CrossRef

24.

Aleman TS, Garrity ST, Brucker AJ. Retinal structure in vitamin A deficiency as explored with multimodal imaging. Doc Ophthalmol. 2013;127:239–43.CrossRef

25.

Smith FR, Goodman DS. The effects of diseases of the liver, thyroid, and kidneys on the transport of vitamin A in human plasma. J Clinl Invest. 1971;50:2426–36.CrossRef

26.

Yeung SC, You Y, Howe KL, Yan P. Choroidal thickness in patients with cardiovascular disease: a review. Surv Ophthalmol. 2020;65:473–86.CrossRef

27.

Read SA, Fuss JA, Vincent SJ, Collins MJ, Alonso-Caneiro D. Choroidal changes in human myopia: insights from optical coherence tomography imaging. Clin Exp Optom. 2019;102:270–85.CrossRef

28.

Yamamoto H, Simon A, Eriksson U, Harris E, Berson EL, Dryja TP. Mutations in the gene encoding 11-cis retinol dehydrogenase cause delayed dark adaptation and fundus albipunctatus. Nat Genet. 1999;22:188–91.CrossRef

29.

Maw MA, Kennedy B, Knight A, Bridges R, Roth KE, Mani EJ, et al. Mutation of the gene encoding cellular retinaldehyde-binding protein in autosomal recessive retinitis pigmentosa. Nat Genet. 1997;17:198–200.CrossRef

30.

Naz S, Ali S, Riazuddin SA, Farooq T, Butt NH, Zafar AU, et al. Mutations in RLBP1 associated with fundus albipunctatus in consanguineous Pakistani families. Br J Ophthalmol. 2011;95:1019–24.CrossRef

31.

Hipp S, Zobor G, Glockle N, Mohr J, Kohl S, Zrenner E, et al. Phenotype variations of retinal dystrophies caused by mutations in the RLBP1 gene. Acta Ophthalmol. 2015;93:e281–6.CrossRef

32.

Schatz P, Preising M, Lorenz B, Sander B, Larsen M, Rosenberg T. Fundus albipunctatus associated with compound heterozygous mutations in RPE65. Ophthalmology. 2011;118:888–94.CrossRef

33.

Li SQ, Xiao XS, Yi Z, Sun WM, Wang PF, Zhang QJ. RPE65 mutation frequency and phenotypic variation according to exome sequencing in a tertiary centre for genetic eye diseases in China. Acta Ophthalmol. 2020;98:e181–90.PubMed

34.

Littink KW, van Genderen MM, van Schooneveld MJ, Visser L, Riemslag FC, Keunen JE, et al. A homozygous frameshift mutation in LRAT causes retinitis punctata albescens. Ophthalmology. 2012;119:1899–906.CrossRef

35.

Katagiri S, Hayashi T, Nakamura M, Mizobuchi K, Gekka T, Komori S, et al. RDH5-related fundus albipunctatus in a large Japanese cohort. Invest Ophthalmol Vis Sci. 2020;61:53.CrossRef

36.

Mochizuki K, Murase H, Imose M, Kawakami H, Sawada A. Improvement of scotopic electroretinograms and night blindness with recovery of serum zinc levels. Jpn J Ophthalmol. 2006;50:532–6.CrossRef

Title: Acquired night blindness due to rod dysfunction after long-term hemodialysis
Authors: Shinji Ueno
Satoshi Okado
Publication date: 01-01-2022
Publisher: Springer Japan
Keyword: Night-Blindness
Published in: Japanese Journal of Ophthalmology / Issue 1/2022
Print ISSN: 0021-5155
Electronic ISSN: 1613-2246
DOI: https://doi.org/10.1007/s10384-021-00883-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Acquired night blindness due to rod dysfunction after long-term hemodialysis

Abstract

Purpose

Study design

Patients and methods

Results

Discussion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Study design

Patients and methods

Results

Discussion

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