Acute visual disorders in patients on regular dialysis given desferrioxamine as a test.

Aluminium (Al) overload has been recognised as a frequent complication in uraemic patients on regular dialysis treatment. We report how acute visual disorders occurred after performing a desferrioxamine (DFO) test in patients on regular dialysis treatment suspected of having aluminium overload. Fifteen patients on regular dialysis treatment for 132 +/- 73 (range 17-250) months, aged 61 +/- 10 (range 47-79) years were given DFO as a test at standard dosage. In the 13 patients who complained of visual disorders, we performed ophthalmologic examinations soon after DFO administration, and again 5 months later in 11 of them. A decrease in visual acuity and/or dyschromatopsia, transient or permanent, were present in ten patients. Four had permanent maculopathy and three also had a permanent alteration of VEP (visual evoked potential). Visual fields were normal in all patients except one who presented a permanent central scotoma. The EOG (electro-oculogram) was permanently impaired in five patients and some of them had fluoroangiographic alterations due to damage of the pigmented epithelium. Six to eight months after the DFO test four patients still complained of visual acuity reduction. We conclude that there is a high rate of visual disorders after giving DFO at the standard doses; therefore we stress the need to modify the doses commonly used and/or the mode of infusion.

Fine needle aspiration biopsy: its use in the management of orbital and intraocular tumors.

In the management of 29 patients by needle aspiration biopsy, a 100% accuracy was obtained in the diagnosis of intra- and extra-bulbar orbital lesions. The technique did not produce any important traumatic complications; there was moderate subconjunctival hemorrhagic suffusion, which spontaneously resolved. The technique proved to be positive in the diagnostic approach to lesions with a difficult access. Its importance in the choice of treatment is discussed, and its effect on the prognosis of intra-ocular tumors is emphasized. It can indeed give specific indications for early treatment of malignant lesions and avoid radical surgery of pseudo-neoplastic benign lesions. As in other sites, the technique is reliable if it is applied in cooperation with an experienced pathologist. It is simple and rapid, inexpensive and well accepted by patients more than other invasive diagnostic procedures.