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Ophthalmic Images
July 12, 2018

Retinal Oxalosis in End-stage Renal Disease

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City
JAMA Ophthalmol. 2018;136(7):e181523. doi:10.1001/jamaophthalmol.2018.1523

A woman in her mid-70s with end-stage renal disease who was receiving more than 3000 mg/d of vitamin C presented after 2 weeks of bilateral vision loss, vomiting, and joint pains. Visual acuity was count fingers OD and 20/800 OS. Results of fundus examination and fluorescein angiography OU were consistent with retinal oxalosis (Figure). Optical coherence tomography angiography showed reflective deposits and capillary nonperfusion in all retinal layers with sparing of the choriocapillaris and choroid. In renal failure, oxalate cannot be excreted and is deposited in various tissues; the patient’s plasma oxalate level was elevated to 187 μmol/L (reference <1.6 μmol/L). She stopped vitamin C supplementation and started daily hemodialysis. One month later, oxalate level was 22 μmol/L, and she had resolution of her systemic symptoms and visual acuity improvement to 20/500 OD and 20/125 OS. Six months after oxalate normalization, she developed bilateral vitreous hemorrhages from neovascularization for which panretinal photocoagulation was performed.

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