Fistula carótido-cavernosa: importancia de su diagnóstico y tratamiento oportunos para prevenir la ceguera / Carotid cavernous fistula: the importance of its opportune diagnosis and treatment to prevent blindness

A carotid cavernous fistula is an abnormal communication between a branch of the carotid artery and the cavernous sinus generating an arteriovenous fistula that can cause severe ocular damage. We hereby report two cases of carotid cavernous fistulas. A 69-year-old male with a 2-month history of right eyelid swelling and red eye aggrarated by diplopia, exophthalmus, and limitation of ocular movements one week before consulting. On admisson his visual acuity, in the right eye was good (0.5) and biomicroscopy showed arterialization of conjunctival vessels. All orbital CAT scan showed a dilatation of the superior orbital vein characteristic of carotid cavernous fistula. A balloon balloon tramponade of the fistula was performed too late (after 3 weeks) and the eye went blind. A 39-year-old female consulted for an acute proptosis of the right eye and severe visual loss. Biomicroscopy showed arterialization of the conjunctival vessels and the CAT scan disclosed a dilatation of the superior orbital vein. She was immediately subjected to a neuroradiological fistula closure with recovery of visual acuity to 1.0 (20/20). Our main purpose is to emphasize the importance of the opportune diagnosis and treatment of these fistulas to prevent visual loss and eventual blindness, as occurred in our first patient.

Fístula carótido-cavernosa: importancia de su diagnóstico y tratamiento oportuno para prevenir la ceguera / Carotid cavernous fistula: importance of its diagnosis and opportune treatment to prevent the blindness

Objetivo: Enfatizar la importancia del diagnóstico clínico y del tratamiento oportuno de las fístulas del seno cavernoso que se manifiestan anterógradamente en la órbita. Pacientes y Métodos: Se presentan dos pacientes atendidos en el Servicio de Oftalmología del Hospital Salvador, tratados endovascularmente en el Instituto de Neurocirugía, quienes presentaron una evolución visual muy disímil (uno llegó a la ceguera y el otro recuperó en 100 por ciento de visión) debido a las diferencias en el tiempo de diagnóstico e inicio del tratamiento. Discusión: Se discuten las diferencias en la expresión clínica de los adversos tipos de fístulas (de bajo y alto flujo), el diagnóstico diferencial y la importancia del tratamiento oportuno para lograr un resultado anatómico y funcional óptimo del ojo afectado.

Características clínicas y respuestas al tratamiento sistémico de la epiescleritis y escleritis primarias y secundarias, refractarias al tratamiento local / Clinical feactures and response to systemic treatment in episcleritis and scleritis resistent to local treatment

Background: Scleritis and episcleritis may extend to adjacent ocular tissues with blinding consequences and may be associated with potentially lethal systemic disorders. Aim: To evaluate the ocular complications and systemic disease associations of the different types of scleritis and episcleritis. Patients and methods: Forty six patients with refractory scleritis and episcleritis were studied and treated during the period 1991 to 1998. Results: Necrotizing type was the most common and severe category in the scleritis group of patients. A decrease in vision occurred in 58.3 percent of patients with scleritis v/s a 23.5 percent of patients with epiescleritis (p<0,05). Uveitis was present in 35.4 percent of patients with scleritis and scleromalacia was present in 33.3 percent (p<0,05). A specific disease association was uncovered in 51 percent of scleritis and in 38 percent of episcleritis patients. Rheumatoid arthritis, primary systemic vasculitic disease and Sjsgren syndrome with vasculitis were the most common associated systemic diseases. Three patients with scleritis had tuberculosis. Conclusions: Scleritis is more severe than episcleritis, and necrotizing scleritis is the most severe type of scleritis. Classification of scleritis and episcleritis provides valuable prognostic information. A meticulous approach for the detection of a specific associated disease must be undertaken. Scleritis associated with vasculitis has a worse ocular prognosis than other non infectious diseases. Cyclophosphamide is the most effective inmunosuppresive treatment to control severe ocular involvement