Pressure-Lowering Effect of Fistula Occlusion in a Patient with Secondary Glaucoma Due to an Intracranial Arteriovenous Fistula

Abstract

IntroductionThis case report presents the pressure-lowering effect of transluminal fistula occlusion in a patient suffering from secondary glaucoma due to carotid cavernous fistula (CCF).Case ReportA 76-year-old Caucasian woman presented with dilated epibulbar vessels with elevated intraocular pressure (IOP, >30 mmHg) as well as glaucomatous excavations of the optic disc in both eyes. Cerebral digital subtraction angiography revealed a CCF with bilateral orbital communication. Preoperative diurnal pressure profiling showed an average IOP of 25.8 mmHg (right eye) and 26.6 mmHg (left eye). Transluminal intervention and fistula occlusion led to a decrease in IOP of about 9 mmHg. A post-operative oculomotor nerve palsy regressed spontaneously.ConclusionSecondary glaucoma due to CCF might be affected by fistula occlusion. Therefore, it should be considered before any surgical glaucoma interventions are performed. Diurnal pressure profiling is an effective tool for monitoring therapeutic success.Electronic supplementary materialThe online version of this article (doi:10.1007/s40123-015-0036-0) contains supplementary material, which is available to authorized users.

Bilateral Blood Reflux Into Schlemm Canals Caused by a Unilateral Dural Sinus Arteriovenous Fistula in a Patient With Cerebral Venous Thrombosis

“…Because no feasible intervention approaches were indicated, the principal ocular concern of our patient is long-term IOP monitoring. Embolization, intermittent carotid massage, and medication have been shown to be effective in controlling secondary IOP elevation due to the fistula (9–11). In our patient, aqueous productions inhibitors including beta-blockers, carbonic anhydrase inhibitors, and alpha agonists will be the top priorities until an endovascular intervention can be performed.…”

Direct and Dural Carotid Cavernous Sinus Fistulas: Comparison of Clinical Characteristics

“…1 Previous studies have reported the ocular manifestations, angiographic features, endovascular management, treatment outcomes and complications in patients with CCFs. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Although there were numerous studies on the clinical findings of these patients in the literature, most of them were small case series, 2,12,15,17,18 or focused on the specific issues. Some studies reported on diagnosis and management of only the dural type.…”

“…[11][12][13][14] Some studies emphasized on endovascular management and treatment outcomes, [7][8][9] whereas others studied on glaucoma management and visual outcome. 5,[16][17][18] To date, information on comparison of clinical characteristics between direct and dural CCF has been limited. 19,20 Therefore, this study aims to report the clinical characteristics of patients with CCFs and compare between the direct and the dural CCFs in a larger series of patients.…”

Drucksenkender Effekt der interventionellen Fistelokklusion bei Sekundärglaukom infolge orbital drainierender intrazerebraler Fisteln

“…Hierzu kommt es, da durch den venösen Rückstau der episklerale Venendruck und somit auch der Druck in den Kollektorvenen des Schlemm-Kanals steigt. Dies führt zu einem verminderten Abfluss und somit zu einem erhöhten IOD 4 , 5 , 6 , 7 .…”

“…This occurs when the venous congestion causes the episcleral venous pressure and therefore the pressure in the collector channels in Schlemmʼs canal to rise. This results in reduced drainage and therefore elevated IOP 4 , 5 , 6 , 7 .…”