CAROTID CAVERNOUS SINUS FISTULA FINDINGS IN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BEFORE AND AFTER PERCUTANEOUS EMBOLIZATION.

BACKGROUND/PURPOSE: Optical coherence tomography angiography has been used to evaluate the posterior segment in a wide variety of pathologies because it is a noninvasive image technique, but its role in the evaluation of the retina in a case of carotid cavernous sinus fistula has not been described yet. METHODS RESULTS: We present a patient who consulted with spontaneous left superior eyelid hematoma and was diagnosed with left indirect carotid cavernous sinus fistula. In this study, optical coherence tomography angiography was used to evaluate the different macular capillary plexuses in a patient with carotid cavernous sinus fistula and a clinical situation of secondary local venous stasis before and after percutaneous embolization. Augmented vessel density was seen in superficial and deep capillary plexuses and in choriocapillaris before the percutaneous embolization, and a decrease of the parameters was seen after the treatment. CONCLUSION: All macular capillary plexuses presented with augmented vessel density levels that normalized after treatment. These findings were previously undescribed, and they suggest that optical coherence tomography angiography may be useful to initially evaluate patients with carotid cavernous sinus fistula who are planned to undergo embolization and to follow them up until normalization of the vascular structures is reported.

Intracrystalline Ozurdex®: therapeutic effect maintained for 18 months.

INTRODUCTION: Ozurdex® is a sterile, sustained-release implant of dexamethasone. The device dissolves within the vitreous body and releases dexamethasone. Here we present a clinical case that demonstrates the sustained therapeutic efficacy of Ozurdex® when accidentally injected into the crystalline lens. METHODS: Case report. RESULTS: Sixty-three-year-old male in which we decided to prescribe the intravitreal injection of a dexamethasone implant (Ozurdex®) in the left eye because of macular oedema after branch retinal vein occlusion. Best-corrected visual acuity (BCVA) was 0.4. At 15 days post-implantation, the slit-lamp examination revealed the dexamethasone implant was located in the crystalline lens. Given there was no inflammation in the anterior pole, no cataracts had developed, the intraocular pressure (IOP) was normal and the macular oedema had been resolved, we decided to assess the efficacy and safety of the dexamethasone implant located in the crystalline lens. The BCVA improved until 14 months post-accidental injection. At 18 months post-Ozurdex® injection the BCVA worsened until 0.05 because of the cataract evolution. Phacoemulsification and intraocular lens placement in sulcus was performed. CONCLUSION: Once the complication has occurred, most authors advocate the early withdrawal of the implanted Ozurdex® device by means of crystalline phacoemulsification and then repositioning it in the vitreous body. However, as long as there are no signs of inflammation in the anterior pole, the IOP is within normal limits, the device does not affect the visual axis and there is no cataract development, we can evaluate the potential therapeutic effect of Ozurdex® in this non-indicated, abnormal location.