Rupture of an aneurysm of the persistent trigeminal artery presenting as a carotid-cavernous sinus fistula.

A 62-year-old Caucasian female presented with spontaneous right-sided eye pain, chemosis and ophthalmoloplegia. A right carotid-cavernous sinus fistula was discovered and successfully treated with transvenous introduction of Guglielmi detachable coils. In addition to complete fistula occlusion, follow-up angiography 6 weeks post-treatment demonstrated the presence of a patent persistent trigeminal artery previously hidden by the caliber of the carotid-cavernous sinus fistula. The spontaneous nature of the presentation and the proximity of the persistent trigeminal artery to the site of coil embolization suggest spontaneous rupture of a persistent trigeminal artery aneurysm as cause of the fistula. Current literature on this finding is discussed here, demonstrating that an aneurysm of the persistent trigeminal artery leading to carotid-cavernous sinus fistula formation is rare. Furthermore, the present case is the first report of its kind in world ophthalmology literature.

Bleb needle redirection for the treatment of early postoperative trabeculectomy leaks: a novel approach.

BACKGROUND: This study describes a technique of bleb needling as a management of early postoperative limbal bleb leaks unresponsive to conservative management. This technique redirects the aqueous into a newly formed bleb, sealing the leak easily and rapidly. METHODS: Medical records of patients with early bleb leaks after trabeculectomy or phacotrabeculectomy between November 2004 and September 2005 were reviewed retrospectively. Patients whose bleb leaks were unresponsive to conservative management and who underwent needling procedures were identified and studied further. RESULTS: Six of 18 patients who had early bleb leaks did not respond to conservative treatment and underwent a needle redirection of their blebs, which sealed within a few days after needling. The mean follow-up time of this group was 6 months. The mean preoperative vision was 20/50 with a mean preoperative intraocular pressure (IOP) of 27 using 2.8 medications, and this improved postoperatively and postneedling to a vision of 20/30 with a mean IOP of 11 using 0.16 medications. INTERPRETATION: Bleb needling with subsequent redirection of aqueous into a new bleb should be considered as an option in the treatment of limbal leaks after a trabeculectomy that does not respond to conservative treatment.

Retrobulbar hemorrhage following strabismus surgery.

Retrobulbar hemorrhage, although a well-known complication of retrobulbar injection, periocular injections, and periocular surgeries, is not routinely associated with strabismus surgery. We present a case of delayed orbital hemorrhage occurring in a young boy 2 days after strabismus surgery.