Images in Nephrology
(Section Editor: G. H. Neild)
Calcareous degeneration of the eye—an unusual complication of uraemic hyperparathyroidism
Faissal Tarrass, Meryem Benjelloun, Mohamed Gharbi Benghanem and Benyounes Ramdani
Department of Nephrology and Dialysis, Ibn Rochd University Hospital Center, 20100 Casablanca, Morocco
Keywords: ESRD; eye involvement; secondary hyperthyroidism
A 34-year-old woman developed chronic renal failure at the age of 15 as a result of chronic glomerulonephritis.
She was maintained on haemodialysis for 6 years. The patient subsequently developed refractory secondary hyperparathyroidism, with ectopic calcification and reduced bone density. A skeletal survey showed calci- fication of the medical sclerosis type affecting arteries of the feet, hands, forearms and pelvis. Her serum bio- chemistry between 1992 and 1999 showed a persistently high calcium phosphate product ranging between 3.6 and 8.9 mmol/l with hypercalcaemia (2.36–2.71 mmol/l) and hyperphosphataemia (2.36–3.42 mmol/l). Investi- gation showed elevated alkaline phosphatase 1872 IU/l, with a grossly elevated parathyroid hormone (PTH) 1759 pg/ml. Total parathyroidectomy was performed in 1999, with the aim of controlling her biochemical abnormalities. As a result, her calcium phosphate product improved to 4.4–4.8 mmol/l and a year later, her PTH decreased to 89 pg/ml. She initially presented to the eye clinic in 1994 with redness and foreign body sensation in both eyes. Fundus examination revealed calcified and attenuated arterioles bilaterally with ischaemic changes. A slitlamp examination was sig- nificant for calcifications of the bulbar conjunctiva in both eyes, with significant conjunctival injection and extensive calcifications of the eyelid margin. Examination showed extensive corneal band keratopathy and limbal calcifications in the right eye (Figure 1). The rest of the anterior segment and the fundoscopic examination results were normal. Because the patient had severe foreign body sensation, it was elected to excise her corneal, conjunctival and eyelid calcifications.
The patient refused all the invasive interventions. Her most recent corrected visual acuity was 7/10 in the left eye and 2/10 in the right eye.
Ocular calcifications have rarely been reported in hypercalcaemic states, such as chronic renal failure and hyperparathyroidism [1,2]. These deposits are mainly associated with corneal, limbal and interpalpebral calcium deposition [1,2].
Conflict of interest statement. None declared.
References
1. Cogan DG, Albright F, Bartter FC. Hypercalcemia and band keratopathy.Arch Ophthal1948; 40: 624–638
2. Chestler RJ, de Venecia G. Calcific eyelid margin lesions in chronic renal failure.Am J Ophthalmol1989; 107: 556–557 Received for publication: 12.6.06
Accepted in revised form: 6.7.06 Correspendance and offprint requests to: Dr Faissal Tarrass,
Salama 3, GR 6, B, No 21, Casablanca, Morocco.
Email: faissal76@hotmail.com
Fig. 1. The patient’s right eye, with extensive corneal calcification.
Nephrol Dial Transplant (2006) 21: 3330–3330 doi:10.1093/ndt/gfl458
Advance Access publication 5 August 2006
ßThe Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
For Permissions, please email: journals.permissions@oxfordjournals.org
