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Alteration of choroidal thickness in a case of carotid cavernous fistula: a case report and a review of the literature.

Shinohara Y, Kashima T, Akiyama H, Kishi S - BMC Ophthalmol (2013)

Bottom Line: To measure the alterations of the choroidal thickness in Carotid cavernous fistula (CCF) using enhanced depth imaging optical coherence tomography (EDI-OCT).She was diagnosed with CCF by magnetic resonance imaging (MRI) and magnetic resonance angiography.Observations; Embolization resulted in improvement of ocular symptoms, and there was a reduction of the subfoveal choroidal thickness in the right eye from 351 μm preoperatively to 142 μm postoperatively in EDI-OCT.EDI-OCT demonstrated that the choroidal thickness increases occurred due to congestion in a CCF case.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology, Gunma University School of Medicine, 3-39-15 Showamachi, Maebashi, Gunma 371-8511, Japan. kasimatomoyuki@yahoo.co.jp.

ABSTRACT

Background: To measure the alterations of the choroidal thickness in Carotid cavernous fistula (CCF) using enhanced depth imaging optical coherence tomography (EDI-OCT).

Case presentation: A 64-year-old woman was referred to us for redness, exophthalmos and visual disturbance in her right eye. She was diagnosed with CCF by magnetic resonance imaging (MRI) and magnetic resonance angiography.Observations; Embolization resulted in improvement of ocular symptoms, and there was a reduction of the subfoveal choroidal thickness in the right eye from 351 μm preoperatively to 142 μm postoperatively in EDI-OCT.

Conclusion: EDI-OCT demonstrated that the choroidal thickness increases occurred due to congestion in a CCF case.

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Related in: MedlinePlus

Right eye fundus photographs. Left photograph: Prior to treatment, the retinal veins exhibit dilatation and tortuosity due to CCF. Right photograph: After treatment, the venous condition returned to normal.
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Figure 2: Right eye fundus photographs. Left photograph: Prior to treatment, the retinal veins exhibit dilatation and tortuosity due to CCF. Right photograph: After treatment, the venous condition returned to normal.

Mentions: A 64-year-old woman developed redness and exophthalmos of her right eye. After undergoing magnetic resonance imaging (MRI), her family doctors, including an ophthalmologist and radiologist, previously diagnosed Graves’ disease based on extraocular muscle swelling and the lack of CCF evidence in the MRI. Although the patient underwent intravenous/oral steroid therapy and radiation therapy treatments, her ocular symptoms did not improve for four months. Since she began to gradually exhibit visual disturbance in her right eye, she was subsequently referred to our hospital 4 month after her symptom. At her first hospital visit, the best-corrected visual acuity of her right and left eye was 20/60 and 20/13, respectively. Intraocular pressure was 15 mmHg in both eyes. Right eye had 3 mm greater protrusion than left eye. (Right = 20 mm Left = 17 mm) Even though her ocular and systemic examinations did not show any signs of thyroid ophthalmopathy except for exophthalmos, we observed dilatation, tortuosity and venous congestion of the conjunctiva and retinal vein in her right eye (Figures 1 and2). Optic nerve edema was not observed. Laboratory tests, which included thyroid profiles such as T3, T4, TSH and TSH receptor antibody, were all within the normal ranges. MRI and magnetic resonance angiography (MRA) determined there was a low flow, which led to suspicion of cavernous sinus-dural arteriovenous fistula (CS-DAVF). Then we performed cerebral angiography and confirmed CS-DAVF which was located at right supraposterior carotid to right superior orbital vein sinus supplied by branch from bilateral middle meningeal artery and meningohypophyseal trunk. The result also revealed subsequent congestion of the choroid in her right eye. One week after the angiography, we performed embolization. Three months after the surgery, embolization of the fistula relieved both the tortuosity and dilatation of the conjunctiva or retinal vein in her right eye. Repeated angiography showed no existence of CS-DAVF and choroidal congestion. Best-corrected visual acuity in her right eye improved to 20/13, all the ophthalmologic signals and symptoms had disappeared. Postoperative MRI showed the dilatation of the superior ophthalmic vein had disappeared. EDI-OCT indicated there was a reduction of the subfoveal choroidal thickness in her right eye from 351 μm preoperatively to 142 μm postoperatively (Figure 3). Laser speckle flowgraphy (LSFG) results showed that the fundus image in her right eye was represented with a cold color as compared to that for her left eye (Figure 4), which indicated congestion of the choroidal blood flow in the right eye. Because LSFG usually shows variation of choroidal blood blow due to the change of systemic condition, calculated affected right eye/ normal left eye ratio showed 55% increase of choroidal blood volume after the operation(before 36.4% after 56.3%). All the clinical surveillance and treatments performed in this patient and during the study complied with the Tenets of the Declaration of Helsinki. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.


Alteration of choroidal thickness in a case of carotid cavernous fistula: a case report and a review of the literature.

Shinohara Y, Kashima T, Akiyama H, Kishi S - BMC Ophthalmol (2013)

Right eye fundus photographs. Left photograph: Prior to treatment, the retinal veins exhibit dilatation and tortuosity due to CCF. Right photograph: After treatment, the venous condition returned to normal.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4234361&req=5

Figure 2: Right eye fundus photographs. Left photograph: Prior to treatment, the retinal veins exhibit dilatation and tortuosity due to CCF. Right photograph: After treatment, the venous condition returned to normal.
Mentions: A 64-year-old woman developed redness and exophthalmos of her right eye. After undergoing magnetic resonance imaging (MRI), her family doctors, including an ophthalmologist and radiologist, previously diagnosed Graves’ disease based on extraocular muscle swelling and the lack of CCF evidence in the MRI. Although the patient underwent intravenous/oral steroid therapy and radiation therapy treatments, her ocular symptoms did not improve for four months. Since she began to gradually exhibit visual disturbance in her right eye, she was subsequently referred to our hospital 4 month after her symptom. At her first hospital visit, the best-corrected visual acuity of her right and left eye was 20/60 and 20/13, respectively. Intraocular pressure was 15 mmHg in both eyes. Right eye had 3 mm greater protrusion than left eye. (Right = 20 mm Left = 17 mm) Even though her ocular and systemic examinations did not show any signs of thyroid ophthalmopathy except for exophthalmos, we observed dilatation, tortuosity and venous congestion of the conjunctiva and retinal vein in her right eye (Figures 1 and2). Optic nerve edema was not observed. Laboratory tests, which included thyroid profiles such as T3, T4, TSH and TSH receptor antibody, were all within the normal ranges. MRI and magnetic resonance angiography (MRA) determined there was a low flow, which led to suspicion of cavernous sinus-dural arteriovenous fistula (CS-DAVF). Then we performed cerebral angiography and confirmed CS-DAVF which was located at right supraposterior carotid to right superior orbital vein sinus supplied by branch from bilateral middle meningeal artery and meningohypophyseal trunk. The result also revealed subsequent congestion of the choroid in her right eye. One week after the angiography, we performed embolization. Three months after the surgery, embolization of the fistula relieved both the tortuosity and dilatation of the conjunctiva or retinal vein in her right eye. Repeated angiography showed no existence of CS-DAVF and choroidal congestion. Best-corrected visual acuity in her right eye improved to 20/13, all the ophthalmologic signals and symptoms had disappeared. Postoperative MRI showed the dilatation of the superior ophthalmic vein had disappeared. EDI-OCT indicated there was a reduction of the subfoveal choroidal thickness in her right eye from 351 μm preoperatively to 142 μm postoperatively (Figure 3). Laser speckle flowgraphy (LSFG) results showed that the fundus image in her right eye was represented with a cold color as compared to that for her left eye (Figure 4), which indicated congestion of the choroidal blood flow in the right eye. Because LSFG usually shows variation of choroidal blood blow due to the change of systemic condition, calculated affected right eye/ normal left eye ratio showed 55% increase of choroidal blood volume after the operation(before 36.4% after 56.3%). All the clinical surveillance and treatments performed in this patient and during the study complied with the Tenets of the Declaration of Helsinki. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

Bottom Line: To measure the alterations of the choroidal thickness in Carotid cavernous fistula (CCF) using enhanced depth imaging optical coherence tomography (EDI-OCT).She was diagnosed with CCF by magnetic resonance imaging (MRI) and magnetic resonance angiography.Observations; Embolization resulted in improvement of ocular symptoms, and there was a reduction of the subfoveal choroidal thickness in the right eye from 351 μm preoperatively to 142 μm postoperatively in EDI-OCT.EDI-OCT demonstrated that the choroidal thickness increases occurred due to congestion in a CCF case.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology, Gunma University School of Medicine, 3-39-15 Showamachi, Maebashi, Gunma 371-8511, Japan. kasimatomoyuki@yahoo.co.jp.

ABSTRACT

Background: To measure the alterations of the choroidal thickness in Carotid cavernous fistula (CCF) using enhanced depth imaging optical coherence tomography (EDI-OCT).

Case presentation: A 64-year-old woman was referred to us for redness, exophthalmos and visual disturbance in her right eye. She was diagnosed with CCF by magnetic resonance imaging (MRI) and magnetic resonance angiography.Observations; Embolization resulted in improvement of ocular symptoms, and there was a reduction of the subfoveal choroidal thickness in the right eye from 351 μm preoperatively to 142 μm postoperatively in EDI-OCT.

Conclusion: EDI-OCT demonstrated that the choroidal thickness increases occurred due to congestion in a CCF case.

Show MeSH
Related in: MedlinePlus