Color Doppler Imaging of Retrobulbar Hemodynamics in a Patient with Glaucoma Duet Associated with Dural Carotid-cavernous Sinus Fistula

Abstract

Although elevated intraocular pressure (IOP) resulting from increased episcleral venous pressure is common in patients with dural carotid-cavernous sinus fistulas (DCFs), neovascular glaucoma (NVG) is rare. A 42-year-old woman with ocular congestive symptoms, including high IOP in her right eye, was diagnosed with right DCF with carotid angiography. Although the symptoms resolved after gamma knife radiosurgery was performed to treat the DCF, central retinal vein occlusion (CRVO) occurred 5 weeks later. Color Doppler ultrasonography indicated the absence of blood flow in the superior ophthalmic vein. This was unlike the retrograde pulsatile blood flow observed with Doppler ultrasonography before the gamma knife radiosurgery. The subsequent development of NVG was treated with a combination of peripheral retinal cryotherapy and diode laser transscleral cyclophotocoagulation. This is the first reported case of CRVO and NVG as complications of DCF after an uneventful gamma knife radiosurgery in a relatively young woman free of systemic cardiovascular or hematologic disorders. Color Doppler ultrasonography delineates orbital hemodynamic changes and helps provide a guide to treat complications associated with DCF.