Pressure-Lowering Effect of Interventional Fistula Occlusion in Secondary Glaucoma due to Orbital Draining Intracerebral Fistulae

Abstract

Background Carotid cavernous sinus fistulas (CSCF) are pathological connections of the internal and/or external carotid artery (and/or its branches) to the cavernous sinus. Ophthalmological symptoms and problems occur particularly when drainage is via the superior ophthalmic vein.

Material and Methods Seven eyes of six patients with a high-grade suspicion of CSCF were included in this retrospective monocentric study. Digital subtraction angiography (DSA) was performed in the included patients, where an interventional fistula closure was performed in the case of CSCF. Four of the six patients received a pre- and post-interventional day-night intraocular pressure profile. Furthermore, medical history, symptoms, visual acuity, slit lamp microscopic findings, and DSA findings were evaluated.

Results The most common symptoms reported by patients were red eyes, diplopia, and exophthalmos. When the intraocular pressure (IOP) was measured, 83.33% of the patients showed increased values. The mean IOP in the day-night intraocular pressure profile in the affected eye before intervention was 23.5 (± 2.7) mmHg compared to 14.1 (± 2.3) mmHg in the healthy eye. A significant difference could thus be demonstrated in side comparison (p = 0.0047). The post-interventional measurement showed a mean IOP of 15.3 (± 1.0) mmHg in the affected eye and thus a significant difference to the pre-interventional measurement in the affected eye (p = 0.0018). Four of the six patients with CSCF were taking antiglaucomatous eye drops before the intervention, and two patients after the intervention. The number of antiglaucoma drugs used could also be reduced.

Conclusion Interventional fistula closure is an effective method for treating the secondary increase of IOP in CSCF. Successful closure of the fistula showed a significant reduction in IOP, which was not possible with the sole administration of antiglaucoma drugs. Radius-Maumenee syndrome should be considered as a differential diagnosis.

Fazit

Bereits bekannt:

• Das sekundäre Offenwinkelglaukom ist eine häufige Komplikation bei Patienten mit CSCF. Dieses ist oftmals schlecht über antiglaukomatöse Augentropfen und konventionelle glaukomchirurgische Eingriffe einzustellen. Bislang gibt es wenige Untersuchungen zum Einfluss einer Fistelokklusion auf den Augeninnendruck.

Neu beschrieben:

• Der Verschluss der CSCF stellt eine effektive Methode zur Senkung des IOD dar.

Conclusion box

Already known:

• Secondary open-angle glaucoma is a frequent complication in patients with a CCF. This is often difficult to adjust with antiglaucomatous eye drops and conventional surgical procedures for glaucoma. To date, there are few studies that examine the influence of fistula occlusion on intraocular eye pressure.

Newly described:

• CCF occlusion is an effective method for lowering IOP.

Key words

cavernous sinus fistula - secondary open-angle glaucoma - Radius Maumenee syndrome

Publication History

Received: 21 October 2022

Accepted: 13 February 2023

Article published online:
31 July 2023

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