Total improvement of ophthalmic findings with treatment in a case with iatrogenic carotid-cavernous fistula

Abstract

A 45-year-old male presented with lid edema and blurred vision in his left eye. He had a history of operation for a sellar and parasellar mass 1 month ago. Best-corrected visual acuity was 7/10 in his left eye. He had marked lid edema, prominent chemosis, episcleral vascular injection, proptosis and mildly congested and tortuous retinal vessels in the left eye. Intraocular pressure was 35mmHg and eye movements were severely restricted in all directions in his left eye. Orbital magnetic resonance (MR) imaging showed left proptosis and cranial venous MR angiography demonstrated multiple tortuous and enlarged vessels near the left carotid artery and the left cavernous sinus resembling carotid-cavernous fistula, and enlarged superior ophthalmic vein. The patient underwent successful endovascular stent-graft implantation for the left iatrogenic carotid-cavernous fistula. At postoperative 3 weeks, visual acuity was 10/10 with complete regression of proptosis and restriction in his left eye.