Ocular manifestations and the clinical course of carotid cavernous sinus fistulas in Asian patients.

PURPOSE: To study the clinical course with regard to both the angiographic and visual outcomes of carotid cavernous fistulas (CCFs). BACKGROUND: Carotid cavernous sinus fistulas (CCFs) are conditions which often present with ocular signs and symptoms. The clinical presentation of CCFs is varied according to the anatomy, haemodynamics and size of the CCF. CCFs causing significant symptoms or vision loss should be treated with embolization. METHODS: This is a retrospective review of the medical records of all CCF cases seen in the Singapore National Eye Centre from September 2002 to December 2011. RESULTS: 45 patients who had confirmed CCF on conventional cerebral angiography were included. Anterior draining CCFs presented with orbital congestion while posterior draining CCFs presented with pain, diplopia and cranial nerve palsies. Mild residual symptoms were still present in 85% of treated direct CCFs despite complete angiographic closure however 52% of treated dural CCFs had complete resolution of symptoms despite only half of those achieving angiographic closure. Treated and untreated dural CCFs had similar outcomes (87% versus 76% recovered or improved (p > 0.05)). Poor outcomes can result from residual diplopia or vision loss from complications of the CCF itself (e.g. compressive optic neuropathy, glaucoma, retinopathy) or complications from CCF embolization treatment (e.g. central retinal artery occlusion). CONCLUSION: Presenting symptoms and signs are related to the angiographic drainage of CCFs. Angiographic outcomes after embolization treatment may not always correlate with clinical outcomes.

Development of thyroid-related orbitopathy following cataract surgery.

AIM: To report a case series of patients who had manifestation or aggravation of thyroid related orbitopathy (TRO) following cataract surgery in an Asian eye centre. METHODS: A systematic review of clinical records of patients with manifestation or aggravation of TRO was conducted. Inclusion criteria were manifestation or aggravation of TRO within 6 months of cataract surgery. RESULTS: Five patients treated for TRO at Singapore National Eye Centre from January 2007 to December 2008 were included in the study. There were 2 males and 3 females with mean age of 54.6 years (range 51-86). Surgery included phacoemulsification with implantation of intraocular lens. The mean interval between surgery and manifestation of symptoms was 7.4 weeks. Contralateral eye involvement was seen in all patients. Clinical presentation of orbitopathy ranged from increased soft issue swelling, proptosis and progression of myopathy to compressive optic neuropathy. One patient had total loss of vision. Mean follow-up was 21 months (range 2-60). CONCLUSION: TRO can present shortly after cataract surgery and lead to serious vision threatening complications. Patients will need to be counseled pre-operatively regarding the risk of post-operative period.