Lopes Edgar Miguel Pontes, Ludovico Inês Cerqueira, Mota Catarina Dinis Mateus Guedes, Xavier Ana Catarina Maltez, Duarte Ana Filipa, Cardigos Joana Sofia Dionísio
Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
Int J Surg Case Rep. 2024 Mar;116:109317. doi: 10.1016/j.ijscr.2024.109317. Epub 2024 Feb 1.
Indirect carotid-cavernous fistula (CCF) can lead to secondary glaucoma, posing significant treatment challenges. This paper discusses a case where standard embolization failed, and an Ahmed FP7 valved glaucoma tube shunt was crucial for managing the increased intraocular pressure (IOP), highlighting the necessity for individualized surgical approaches.
A 48-year-old female presented in the emergency department with conjunctival hyperemia, proptosis and elevated IOP; initial imaging findings were indicative of orbital inflammatory disease. Further evaluation with cerebral CT angiography revealed a possible CCF. Subsequent angiography confirmed an indirect CCF type D, leading to the patient undergoing endovascular embolization. Final monitoring revealed a subtotal occlusion of the fistula. Although there was some improvement post-procedure, IOP remained elevated despite medication, and subsequent attempts of embolization were unsuccessful. Surgical intervention with a tube shunt was performed, allowing IOP to decreased to a normal range. Optic nerve head optical coherence tomography, standard automated perimetry, and best-corrected visual acuity remained stable during the 33-month follow-up.
In managing glaucoma linked to CCF, a multidisciplinary approach is critical. Conservative methods are often adequate, with spontaneous CCF closure observed in a significant percentage. Endovascular embolization is reserved for refractory cases, with embolization showing a higher rate of IOP normalization compared to medication alone. Yet, when fistula closure is challenging or contraindicated, individualized management strategies like glaucoma surgery may be employed.
When fistula closure is not achievable, the Ahmed FP7 valved tube shunt can successfully regulate IOP with minimal complications, providing an effective alternative for refractory cases.
间接性颈内动脉海绵窦瘘（CCF）可导致继发性青光眼，带来重大治疗挑战。本文讨论了一例标准栓塞术失败的病例，其中艾哈迈德FP7带阀青光眼引流管对于控制眼内压升高至关重要，突出了个体化手术方法的必要性。
一名48岁女性因结膜充血、眼球突出和眼压升高就诊于急诊科；初始影像学检查结果提示眼眶炎性疾病。进一步的脑部CT血管造影评估显示可能为CCF。随后的血管造影证实为D型间接CCF，患者接受了血管内栓塞术。最终监测显示瘘管次全闭塞。尽管术后有一定改善，但尽管使用了药物，眼压仍居高不下，随后的栓塞尝试均未成功。进行了带分流管的手术干预，使眼压降至正常范围。在33个月的随访期间，视神经乳头光学相干断层扫描、标准自动视野检查和最佳矫正视力保持稳定。
在处理与CCF相关的青光眼时，多学科方法至关重要。保守方法通常就足够了，相当比例的患者可观察到CCF自发闭合。血管内栓塞术用于难治性病例，与单独使用药物相比，栓塞术使眼压正常化的比例更高。然而，当瘘管闭合具有挑战性或存在禁忌时，可能会采用如青光眼手术等个体化管理策略。
当无法实现瘘管闭合时，艾哈迈德FP7带阀分流管可成功调节眼压，并发症最少，为难治性病例提供了一种有效的替代方法。
