Venous Stasis Retinopathy Complicating a Case of Cavernous-carotid Fistula with an Initial Normal Computed Tomography Angiogram of the Brain

Carotid-cavernous fistula (CCF) can be spontaneous or due to trauma. Due to its complication to the eye, diagnosis and intervention should not be delayed. We report a case of an elderly female who presented with left eye redness with gradual onset of protrusion over the same eye. She was suspected to have CCF with the clinical presentation. Nevertheless, she had a normal computed tomography angiogram of the brain. Later, she was scheduled for cerebral angiography and the diagnosis of CCF was confirmed. However, due to delay in diagnosis and treatment, the patient developed venous stasis retinopathy and neovascular glaucoma. Her vision remained poor despite aggressive systemic and ocular treatments. This case report is to emphasise the importance of clinical suspicion of a disease despite a normal imaging. This is to prevent irreversible blindness and other systemic complications.

Venous stasis retinopathy in a ten-year-old boy with ocular hypertension: a case report

Background Central retinal vein occlusion is a variable disease pattern. Preliminary stages of a complete occlusion of the central vein, wich are subsumed under the term venous stasis retinopathy, may occur as transient blurred vision and with subtle alterations of the fundus. Course and prognosis are benign, visual acuity usually recovers. By now, venous stasis retinopathy in children due to Valsalva maneuver has not been described in literature yet. Case presentation We present an impressive case of venous stasis retinopathy in a 10-year-old boy with ocular hypertension and megalocornea due to increased intraocular pressure provoked by Valsalva maneuver. Main symptom was transient blurred vision in the left eye. The intraocular pressure was 28 mmHg, fundus exam revealed tortuous veins and a flame shaped hemorrhage at 7 o’clock. Total recovery under topical antiglaucomatous therapy could be observed after 1 month. Conclusions Acute increase in intraocular pressure, provoked by Valsalva maneuver is a risk factor for venous stasis retinopathy. Further general and vascular risk factors should be ruled out by extensive examination. Children with ocular hypertension might be at higher risk for impending vein occlusion as shown in this case.

Decompression Retinopathy Following Trabeculectomy: A Case Report

Introduction: Decompression retinopathy (DR) can have varied manifestations as retinal and vitreous hemorrhage, disc edema, and macular edema. Vein occlusion associated with choroidal detachment (CD) has not been reported so far as a feature of DR. Case: We report a case of a 78 year old male with bilateral primary open angle glaucoma (POAG) on maximal topical medication with progressive field loss. Trabeculectomy with mitomycin C was done in the left eye, and the patient developed hypotony in the immediate postoperative period which was managed conservatively. After six weeks he developed CD, vein occlusion and macular edema. Thus, Anti VEGF was given and in other eye filtration surgery was done with all measures to avoid sudden hypotony. Patient still developed CD in the right eye. For which, he was given oral and topical steroids in tapering dose. After one month there was resolution of macular edema in the left eye and choroidal detachment resolved in both eyes and IOP was in lower teens in both eyes. Conclusion: Venous stasis retinopathy and choroidal detachment can be the manifestations of decompression retinopathy following glaucoma filtering surgery. The advancement in imaging modalities now can help us find the pathogenesis of the condition and validation of previous hypothesis proposed. Early identification and management of retinopathy helps in resolution with good visual recovery.

Fulminant Idiopathic Intracranial Hypertension and Venous Stasis Retinopathy Resulting in Severe Bilateral Visual Impairment

Purpose To report a complicated case of fulminant idiopathic intracranial hypertension and concomitant venous stasis retinopathy leading to postpapilledema optic atrophy. Methods Case report. Results A 34-year-old morbidly obese woman with a history of idiopathic intracranial hypertension (IIH) presented with a 1-month history of bilateral vision loss, diplopia, and left eye pain after being lost to follow-up for 6 years. Fundus examination revealed florid papilledema with venous tortuosity bilaterally. Brain and orbit magnetic resonance imaging showed bilateral globe flattening, intraocular optic nerve swelling in both eyes, and no abnormality on magnetic resonance venography. After additional workup including lumbar puncture with an opening pressure of 55 cm H2O, a diagnosis of IIH was confirmed. Medical treatment with oral carbonic anhydrase inhibitors was initiated, followed by same-day bilateral optic nerve sheath decompression and ventriculoperitoneal shunt placement the following week. Fundus examination 2 months later revealed a persistent blood and thunder fundus suggestive of bilateral central retinal vein occlusions. Over the course of 6 months, both eyes displayed postpapilledema optic atrophy with light perception and hand motion vision in the right and left eyes, respectively. On Goldmann perimetry, the patient had vague limited isolated responses in both eyes to the largest target. Conclusions Fulminant IIH can present with profoundly blinding complications recalcitrant to aggressive medical and surgical intervention. Central retinal vein occlusion is an uncommon blinding complication of IIH.