Increased Intraocular Pressure in Patients with Carotid-Cavernous Fistula Seen at a Tertiary Eye Care Center
Patricia Anne C. Concepcion MD1,2, Nilo Vincent dG. FlorCruz II MD1
1Department of Ophthalmology and Visual Sciences, Philippine General Hospital, Manila
2Department of Ophthalmology, Ilocos Training and Regional Medical Center, La Union
Corresponding Author: Patricia Anne C. Concepcion, MD
Clinic Address: Department of Ophthalmology, Ilocos Training and Regional Medical Center, Parian, City of San Fernando, La Union
Contact Number: +63-72-6076418 loc. 306
Email Address: triciaconcepcion.md@gmail.com
Disclosure: The authors report no conflict of interest. No financial support was received for the study.
ABSTRACT
Objectives: We described the demographic and clinical profiles of patients with carotid-cavernous fistula (CCF), determined the prevalence of increased intraocular pressure (IOP), and described the IOP outcomes after endovascular treatment.
Methods: This was a single-center, retrospective review of records of patients with clinical signs and radiologic evidence of CCF from January 2012 to December 2017. Outcome measures included the prevalence of increased IOP in those with CCF, mean and range of IOPs, average number of IOP-lowering medications needed, and percentage of eyes with normal, controlled, and uncontrolled IOP before and after endovascular intervention.
Results: Ninety-six (96) eyes of 92 patients with radiologic evidence of CCF on 4-vessel cerebral angiography were included. Fifty-nine (59) percent were between the ages of 20 to 39 years. Majority (65%) were males. Direct CCFs accounted for 70% of cases. Increased IOP was the third most common ocular sign with a prevalence of 78%, ranging from 10 to 56 mmHg (mean 20.3 ± 8.0). The average number of antiglaucoma medications for IOP control was 2. Eleven (11) underwent definitive management for CCF. Post-treatment, 33% of 13 eyes had normal, 27% controlled, and 40% uncontrolled IOPs.
Conclusion: There was a high prevalence of increased IOP in patients with CCF. Those who did not achieve IOP control should be referred for endovascular intervention to prevent serious complications, including secondary glaucoma.
Keywords: secondary ocular hypertension, secondary glaucoma, intraocular pressure, carotid-cavernous fistula, episcleral venous pressure