Department of Orbit Oculoplasty Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, India.
Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India.
Sci Rep. 2019 Sep 6;9(1):12872. doi: 10.1038/s41598-019-49342-3.
Our aim is to study the varied posterior segment manifestations, level of visual impairment (VI) and its causes in carotid cavernous fistula (CCF) patients. A retrospective study was done, wherein data was obtained from 48 digital subtraction angiogram (DSA) proven CCF patients. CCF was classified according to Barrow et al., based on DSA into type A (high flow) and types B, C and D (low flow). High flow CCF was present in 8 (16.7%) and low flow CCF was present in 42 (83.3%). Compared to low flow group, patients in high flow group were younger and had a history of trauma (p < 0.05). Posterior segment findings ranged from familiar stasis retinopathy and optic neuropathy (both, glaucomatous and ischemic) to uncommon findings of central retinal artery occlusion, Terson syndrome and combined retinal and choroidal detachment. Retinal vein dilatation was the most common finding in both groups. The high flow CCF group had 6 (75%) patients that had VI. This was acute in 4 (50%) patients and delayed in 2 (25%). In the low flow group 10 (23.8%) of patients had delayed VI. The identification of "3 point sign" is a novel finding of this study, not described before. While none of three findings (disc hyperaemia, retinal vein dilatation and intra-retinal haemorrhage) in isolation were predictive of visual loss, but when present together results in visual loss. Posterior segment changes were varied, some are uncommon and can occur in various combinations. "3 point sign" must be identified at the earliest to prevent visual impairment. The incidence of VI in CCF patients is high.
我们的目的是研究颈动脉海绵窦瘘（CCF）患者的各种后段表现、视力损害（VI）程度及其原因。进行了一项回顾性研究，从中获取了 48 例经数字减影血管造影（DSA）证实的 CCF 患者的数据。根据 DSA，CCF 按照 Barrow 等人的分类分为 A 型（高流量）和 B、C 和 D 型（低流量）。8 例（16.7%）为高流量 CCF，42 例（83.3%）为低流量 CCF。与低流量组相比，高流量组患者更年轻，有创伤史（p<0.05）。后段表现从常见的淤滞性视网膜病变和视神经病变（包括青光眼性和缺血性病变）到不常见的视网膜中央动脉阻塞、Terson 综合征和视网膜及脉络膜联合脱离。视网膜静脉扩张是两组中最常见的发现。高流量 CCF 组有 6 例（75%）患者存在 VI。其中 4 例（50%）为急性 VI，2 例（25%）为迟发性 VI。在低流量组中，有 10 例（23.8%）患者存在迟发性 VI。“三点征”的识别是本研究的一个新发现，以前没有描述过。虽然孤立的三个发现（视盘充血、视网膜静脉扩张和视网膜内出血）都不能预测视力丧失，但当同时存在时会导致视力丧失。后段改变多种多样，有些不常见，并且可以以各种组合出现。“三点征”必须尽早识别，以防止视力损害。CCF 患者 VI 的发生率很高。
