Sigurdsson Samuel, Bohman Elin, Träisk Frank, Arnljots Urszula
St. Erik Eye Hospital, Stockholm, Sweden.
Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Am J Ophthalmol Case Rep. 2024 Mar 2;34:102027. doi: 10.1016/j.ajoc.2024.102027. eCollection 2024 Jun.
Superior ophthalmic vein thrombosis (SOVT) is a rare clinical entity, which can have a septic and an aseptic cause. Aseptic SOVT is typically treated with anticoagulation. Glucocorticoids are reserved for cases with concurrent orbital inflammation.We present three cases of SOVT due to carotid cavernous fistula not responding to standard treatment, subsequently successfully treated with glucocorticoids.
Three patients with various degrees of proptosis, ophthalmoplegia, orbital stasis and reduced vision are presented. One patient was confirmed to have isolated SOVT, while the other two had associated cavernous sinus thrombosis. All patients had underlying carotid-cavernous fistula without signs of infection. All patients were initially treated with parenteral anticoagulation. Two patients were treated with intraocular pressure-reducing medication. One of whom underwent canthotomy-cantholysis. Two patients experienced a gradual worsening of symptoms during treatment with anticoagulation, while one patient improved before deteriorating. All patients received additional treatment with glucocorticoids consisting of a three-day treatment with intravenous methylprednisolone 500 mg, followed by oral glucocorticoids resulting in total regression of symptoms. Two patients regained 20/20 vision, with some vision field defects, while the third patient regained 20/25 vision.
The addition of glucocorticoids in the treatment of aseptic SOVT can lead to improvement of symptoms and a potentially better prognosis. However, the risk of complications of glucocorticoid treatment must be carefully considered on a case-by-case basis.
眼上静脉血栓形成（SOVT）是一种罕见的临床病症，其病因可分为感染性和非感染性。非感染性SOVT通常采用抗凝治疗。糖皮质激素仅用于并发眼眶炎症的病例。我们报告了3例因颈动脉海绵窦瘘导致的SOVT，这些病例对标准治疗无反应，随后使用糖皮质激素成功治愈。
报告了3例有不同程度眼球突出、眼肌麻痹、眼眶瘀血和视力下降的患者。1例患者确诊为孤立性SOVT，另外2例伴有海绵窦血栓形成。所有患者均有潜在的颈动脉海绵窦瘘且无感染迹象。所有患者最初均接受胃肠外抗凝治疗。2例患者接受了降眼压药物治疗。其中1例患者接受了内外眦切开术。2例患者在抗凝治疗期间症状逐渐恶化，而1例患者在病情恶化前有所改善。所有患者均接受了糖皮质激素的额外治疗，包括静脉注射甲泼尼龙500mg，为期3天，随后口服糖皮质激素，症状完全消退。2例患者视力恢复到20/20，但有一些视野缺损，而第3例患者视力恢复到20/25。
在非感染性SOVT治疗中加用糖皮质激素可改善症状并可能带来更好的预后。然而，必须根据具体情况仔细考虑糖皮质激素治疗的并发症风险。
