We appreciate the comments of Basu and Jain, and
their observation of retinal detachment, severe hypertension and
chronic renal failure (CRF). The authors have asked about a routine
ophthalmologic examination. Detailed opthalmological examination was
done only in subjects who had visual problems or hypertension in
addition to those with hereditary nephropathy. In our series of 305
patients, 134 (43.8%) had hypertension and all these underwent eye
evaluation. Patients had mild to moderate hypertensive changes in the
fundus but none had retinal detachment. There is a possibility that
subclinical detachment could have been missed in those who were not
There are occasional case reports of retinal
detachment in association with CRF in adults but the only reported
retinal changes associated with pediatric CRF are retinal degeneration
and retinitis pigmentosa(1-3). Even in adults it is a relatively
uncommon complication. In a report on 330 patients of pediatric
retinal detachment in children, the chief causes were myopia,
retinoschisis, cataract, glaucoma and ocular traum(4). There are some
anecdotal reports of association of retinal detachment with
hypertension in childhood, but none had underlying CRF(5).
Based on the results of our patients that underwent
eye examination, retinal detach-ment seems uncommon in children with
CRF. The etiology of CRF as well as the fluid and electrolyte
abnomalities are different in children as compared to adults, which
might explain the relative paucity of ocular complications in them.
Department of Pediatrics,
All India Institute of Medical Sciences,
New Delhi-110 029, India.
1. Wagdi S, Dumas J, Labelle P. Retinal detachment
in renal insufficiency: A report of 3 cases. Can J Opthalmol 1978; 13:
2. Grass JD. Bullous retinal detachment and
multiple retinal pigment epithelial detachments in patients receiving
hemodialysis. Graefes Arch Clin Exp 1992; 120: 454-458.
3. Arias M, Zubimendi JA, Val F, de Castro S,
Llamazares C. Familial interstitial chronic nephropathy [nephronopthisis
and tape-to-retinal degeneration (Senior-Loken synd-rome)]. Rev Clin
Esp 1975; 138: 481-485.
4. Lemrini F, Dafrallah L, Kabbaj A. Retinal
detachment in children. J Fr Opthalmol 1993; 16: 159-164.
5. Meire FM, De Laey JJ, Van Thienen MN, Schuddinck L. Retinal
manifestations in fibromuscular dysplasia. Eur J Opthalmol 1991; 1: