I am taking care of a 70-year old diabetic lady on hemodialysis. She is blind in the right eye and has secondary glaucoma in the left eye. Her retinopathy on the left side is stable after laser coagulation and she has undergone a vitrectomy on the left. She had received a drainage system for her glaucoma, which had to be explanted 2 weeks ago following an endophthalmitis. There are no other operative options for her glaucoma. Presently she has massive increases in intraocular pressures on the left (e.g. 15 to 55 mmHg) during every HD and may completely loose her vision. The literature on intraocular pressure during HD is extremely variable (with about 1/3 describing increases, decreases or no change, respectively) but almost never describes such magnitudes of increases.
Switching to PD is not an option given her social situation. Infusion of a hyperosmolar agent on HD would make little sense according to our ophthalmogists given her prior vitrectomy. She regularly becomes hypotensive on HD but again, our ophthalmogists see little rationale for pressure agents.
Any other advice? Thank you!