Case Report: Recurrent intraocular pressure elevation during hemodialysis in a patient with pseudoexfoliation glaucoma
Bibliographic record
Abstract
Introduction: Intraocular pressure (IOP) elevation during dialysis has been observed in patients with glaucoma. This is thought to result from rapid shifts in plasma osmolality, leading to fluid movement into the anterior chamber, a phenomenon referred to as ocular dialysis disequilibrium. This case highlights a patient with advanced pseudoexfoliation glaucoma who developed recurrent, symptomatic IOP spikes during dialysis, posing management challenges. Methods: Case report. Results: A 65-year-old male with advanced pseudoexfoliation glaucoma experienced recurrent left eye pain and vision loss during hemodialysis, with IOP spikes up to mid 50s (mmHg), requiring early dialysis termination. Medical management including topical drops, oral acetazolamide, and dialysis modifications failed to adequately control IOP. The patient later underwent Ahmed glaucoma valve implantation which stabilized IOP (8-13 mmHg), eliminated dialysis-related pain, and allowed return to standard dialysis sessions. At 6 months, visual acuity was 20/80 + 2 OS with IOP well controlled on topical therapy. Conclusion: This case demonstrates that ocular dialysis disequilibrium can cause symptomatic IOP spikes in glaucoma patients and may be unresponsive to medical therapy alone. Surgical intervention may be necessary for long-term IOP control. Early recognition and interdisciplinary coordination between ophthalmology and nephrology is critical to prevent irreversible vision loss.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.006 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".