Saatci Ali Osman, Selver Ozlem Barut, Men Suleyman, Bajin Meltem Soylev
Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey.
Clin Exp Optom. 2014 Jan;97(1):90-3. doi: 10.1111/cxo.12042. Epub 2013 Apr 8.
We report a patient with optic disc neovasculariation due to possibly traumatic direct carotid cavernous fistula treated by a single dose of intravitreal ranibizumab prior to neurointervention. A 25-year-old man had a 10-month history of bilateral proptosis and left sixth nerve paralysis was evaluated. Conjunctival vessels were markedly dilated, especially in the left eye. Clinical examination and fundus fluorescein angiography revealed disc neovascularisation in the left eye with subtle peripheral retinal ischaemia. Magnetic resonance imaging suggested a high-flow carotid cavernous fistula on the left side and this was confirmed by catheter angiography. A single dose of intravitreal ranibizumab was injected prior to neuro-intervention. The disc neovascularisation regressed completely three days later. The left direct carotid cavernous fistula was later treated successfully with coil embolisation. Optic disc neovascularisation is a very rare feature of carotid cavernous fistula and intravitreal ranibizumab may be a useful therapeutic adjunct prior to neuro-interventional techniques to reduce neovascularisation-induced haemorrhage following the intervention.
我们报告了一名因可能的创伤性直接颈动脉海绵窦瘘导致视盘新生血管形成的患者，在神经介入治疗前接受了单剂量玻璃体内注射雷珠单抗治疗。一名25岁男性，有10个月的双侧眼球突出病史，伴有左侧展神经麻痹，前来接受评估。结膜血管明显扩张，尤其是左眼。临床检查和眼底荧光血管造影显示左眼视盘新生血管形成，伴有轻微的周边视网膜缺血。磁共振成像提示左侧为高流量颈动脉海绵窦瘘，导管血管造影证实了这一点。在神经介入治疗前注射了单剂量玻璃体内雷珠单抗。三天后视盘新生血管完全消退。随后，左侧直接颈动脉海绵窦瘘通过弹簧圈栓塞成功治疗。视盘新生血管形成是颈动脉海绵窦瘘非常罕见的特征，玻璃体内注射雷珠单抗可能是神经介入技术前一种有用的治疗辅助手段，可减少介入后新生血管形成引起的出血。
