Ocular manifestations and prognosis of secondary glaucoma in patients with carotid-cavernous fistula.

Purpose: To study the frequency of ocular manifestations and the prognosis of secondary glaucoma in cases of carotid-cavernous fistula (CCF).

Methods: A retrospective multicenter study was conducted to investigate causes, types, ocular symptoms, complications, treatment, and prognosis in subjects with CCF.

Results: Among the 43 patients diagnosed with CCF between 1984 and 2000, a total of 13 patients (14 eyes) showed ocular manifestations. CCF was idiopathic in 13 eyes of 12 subjects and resulted from head trauma in 1 eye of 1 subject. Among the ocular symptoms and complications, conjunctival hyperemia was most common, occurring at a rate of 92.9% of the eyes, followed by exophthalmos at 50%, retinal hemorrhaging at 50%, retinal venous dilation at 42.9%, vascular bruits at 28.6%, injection of Schlemm's canal at 21.4%, and external ophthalmoplegia at 21.4%. Elevated intraocular pressure (IOP) occurred at a rate of 64.3%, with maximum IOP ranging from 22-55 mm Hg. At the time of the final observation, IOP control was favorable in 6 of the 9 eyes showing elevated IOP; 5 of these 9 eyes showed a closed CCF, but none required antiglaucoma treatment, with the exception of 1 eye for which trabeculectomy was performed. IOP control was unfavorable in the remaining 3 eyes, and in 1 of these eyes CCF was not closed.

Conclusions: Secondary glaucoma is a frequently observed ocular manifestation of CCF, and closure of the fistula is the primary condition required for favorable IOP control.