Optical coherence tomography in the carotid-cavernous fistula
Keywords:
carotid-cavernous fistula; optical coherence tomography; subfoveal choroidal thickness; cerebral angiography; paralytic strabismusAbstract
Carotid-cavernous fistula is a rare and clinically significant condition requiring a multidisciplinary diagnostic and therapeutic approach. Optical coherence tomography emerges as a complementary tool in its evaluation, particularly through the assessment of choroidal thickness changes. A 67-year-old female with spontaneous direct carotid-cavernous fistula initially presented with right periocular pain and treatment resistant ocular hypertension. Ophthalmological manifestations included proptosis, conjunctival hyperemia with corkscrew vessels, ophthalmoplegia due to right sixth cranial nerve paresis, and fundus changes leading to suspected carotid-cavernous fistula. Optical coherence tomography revealed a significant increase in subfoveal choroidal thickness in the right eye of 236 μm, compared to 170 μm in the left eye. Cerebral angiography confirmed the diagnosis of direct carotid-cavernous fistula. After endovascular treatment, subfoveal choroidal thickness normalized to 171 μm. Persistent diplopia required botulinum toxin A injection for residual paralytic strabismus correction, with complete symptom resolution. Subfoveal choroidal thickness measurement through optical coherence tomography emerges as a useful complementary tool in the diagnosis and monitoring of carotidcavernous fistula, providing objective parameters to evaluate evolution and treatment response.
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1. Magana-García D, de la Vega ATR, Siu-Villasenor D, Romo-García E. Fístula carótido-cavernosa asociada al parto. Rev Mex Oftalmol. 2016;90(4):182-7. DOI: https://doi.org/10.1016/j.mexoft.2015.06.002
2. Henderson AD, Miller NR. Carotid-cavernous fistula: Current concepts in aetiology, investigation, and management. Eye. 2018;32(2):164-72. DOI: https://doi.org/10.1038/eye.2017.240
3. Vilela MAP. Carotid-cavernous fistula. Rev Bras Oftalmol. 2013;72(1):70-5. DOI: https://doi.org/10.1590/S0034-72802013000100015
4. Alam MS, Jain M, Mukherjee B, Sharma T, Halbe S, Jaisankar D, et al. Visual impairment in high flow and low flow carotid cavernous fistula. Sci Rep. 2019;9(1):12872. DOI: https://doi.org/10.1038/s41598-019-49342-3
5. Bonafede L, Patel A, El-Dairi M, Ozzello DJ, Velez FG. Acute onset variable and progressive trochlear nerve palsy and ophthalmoparesis secondary to bilateral carotid cavernous fistula. J Binocul Vis Ocul Motil. 2021;71(2):50-4. DOI: https://doi.org/10.1080/2576117x.2021.1903670
6. Khurana M, Alam MS, Balekudaru S, Vijaya L, Madhuri MB, Halbe SV, et al. Intraocular pressure in the eyes of patients with carotid-cavernous fistulas: profile, intereye asymmetry, and treatment outcomes. J Glaucoma. 2019;28(12):1074-8. DOI: https://doi.org/10.1097/ijg.0000000000001392
7. Shinohara Y, Kashima T, Akiyama H, Kishi S. Alteration of choroidal thickness in a case of carotid cavernous fistula: a case report and a review of the literature. BMC Ophthalmol. 2013;13:75. DOI: https://doi.org/10.1186/1471-2415-13-75
8. González J, Sales-Sanz M, Oblanca-Llamazares N, Bustos-García A, Méndez-Cendón JC, Fandiño E. Choroidal thickening in a case of carotid cavernous fistula. Orbit. 2018;37(4):306-8. DOI: https://doi.org/10.1080/01676830.2017.1423338
9. Ang M, Sng C, Milea D. Optical coherence tomography angiography in dural carotid-cavernous sinus fistula. BMC Ophthalmol. 2016;16:93. DOI: https://doi.org/10.1186/s12886-016-0278-1
10. Wang X, Zhang X, Gan L, Wang Y, Ma J, Zhong Y. Observation of fundus and optical coherence tomography angiography manifestations in carotid cavernous fistula patients. Graefes Arch Clin Exp Ophthalmol. 2021;259(9):2573-82. DOI: https://doi.org/10.1007/s00417-021-05117-z
11. Rey A, Castillo L, Dyrda A, Maseras X, Jürgens I. Subfoveal choroidal thickness changes in carotid cavernous fistula following spontaneous resolution. BMC Ophthalmol. 2016;16:63. DOI: https://doi.org/10.1186/s12886-016-0240-2
12. Inam O, Arat YO, Yavas GF, Arat A. Retinal and choroidal optical coherence tomography findings of carotid cavernous fistula. Am J Ophthalmol. 2019;206:264-73. DOI: https://doi.org/10.1016/j.ajo.2019.06.010
13. Pascual-Camps I, Martínez-Rubio C, Gallego-Pinazo R, España-Gregori E. Optical coherence tomography characterization of macular changes secondary to arteriovenous fistula. Neuro-Ophthalmol Aeolus Press. 2017;42(3):182-6. DOI: https://doi.org/10.1080/01658107.2017.1371768
14. Zhu L, Liu B, Zhong J. Post-traumatic right carotid-cavernous fistula resulting in symptoms in the contralateral eye: a case report and literature review. BMC Ophthalmol. 2018;18(1):183. DOI: https://doi.org/10.1186/s12886-018-0863-6
15. Calle MI, Hernández OH. Fístula carótido-cavernosa espontánea bilateral: reporte de caso y revisión de la literatura. Acta Colomb Cuid Intens. 2016;16(1):23-30. DOI: https://doi.org/10.1016/j.acci.2015.10.002
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