The eye remembers: Retinal oxalate deposition after curative transplant in primary hyperoxaluria

A 55-year-old female diagnosed as primary hyperoxaluria underwent curative combined liver–kidney transplantation being on hemodialysis for the past 2 years. The best corrected visual acuity in both eyes was 20/40 with an unremarkable anterior eye segment. Fundus showed bilateral numerous, discrete, yellowish crystalline deposits with optical coherence tomography revealing these deposits to be distributed in various retinal layers and subretinal pigment epithelial (RPE) space [Fig. 1a-d]. Findings were consistent with grade 3 oxalate retinopathy.[1] Primary hyperoxaluria is a rare inherited disorder causing endogenous overproduction of oxalate, with extrarenal deposition.[2] The oxalate deposits may persist or worsen transiently post transplant due to mobilization of pre-existing tissue stores, delayed systemic clearance, or ongoing deposition.[3]Figure 1: (a and b) Fundus image of right [a] and left [b] eyes showing numerous yellow-white crystalline deposits across the posterior pole and along vessel walls (black arrows). (c and d) Corresponding optical coherence tomography of right [c] and left [d] eyes reveal focal hyper-reflective lesions in all retinal layers (yellow arrows), with subretinal and sub-RPE spaces (white arrows), indicating crystallized oxalate depositionAuthor’s contributions Dr. Priyanka Patel: Data collection, Images acquisition, Literature search and Manuscript preparation. Dr. Vivek Chaitanya: Concept, Design, Manuscript editing and Review. Declaration of patient consent The author certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in this journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.