Embolization of dural carotid-cavernous fistulas via the thrombosed superior ophthalmic vein

Purpose: To present the authors' experience treating dural carotid-cavernous sinus fistulas (CCF) with retrograde embolization via the thrombosed superior ophthalmic vein (SOV). Methods: The medical records of 4 patients with dural CCFs treated via the thrombosed SOV were reviewed. All procedures were performed unilaterally in the interventional radiology unit with the administration of general anesthesia. The SOV was exposed via an eyelid crease incision, and then an angiocatheter was inserted in the vein and advanced through the segment with thrombosis to the cavernous sinus, where embolizing agents were deposited. After the procedure, the patients were followed up and evaluated clinically. Results: Three patients had unilateral CCFs, and 1 had a bilateral CCF (3 women and 1 man; age range, 58-68 years). The CCFs were Barrow type B (n = 2) and Barrow type D (n = 2). All patients had severe venous congestive orbital symptoms, chorioretinopathy, increased intraocular pressure, and visual loss. In all cases, the SOV appeared as a pale, thin, tortuous vessel adherent to the surrounding tissues during the surgical procedure. In 3 patients, the cavernous sinus was successfully embolized, and all symptoms were completely resolved without recurrence during follow up (3, 15, and 24 months). In the patient in whom the SOV could not be catheterized, the symptoms regressed slowly, but visual acuity remained unchanged during follow up (64 months). Conclusions: Dural CCFs can be successfully treated through the SOV, even when the vein is thrombosed. Identification and catheterization of the thrombosed SOV may be difficult because of the tiny and fibrotic structure of the vein

Olası Herpetik Ön Üveitlerde Göz İçi Basıncı Yüksekliğinin Sıklığı ve Prognozu

Purpose: To determine the prevalence of elevated intraocular pressure (IOP) and to investigate the effect of clinical signs on its prognosis in patients with presumed herpetic anterior uveitis.Materials and Methods: the medical records of patients diagnosed as herpetic anterior uveitis were reviewed. Patients were divided into 3 groups, as having normal IOP during the course (Group 1), ocular hypertension (OHT) (Group 2) and secondary glaucoma (Group 3). Relationship between clinical signs and outcomes were investigated.Results: Sixty-six eyes of 66 patients (32 female, 34 male) were included in the study. the mean age was 49.2±18.9 years, the mean follow-up time was 20.7±23.2 months. During follow-up elevated IOP was noted in 41 eyes (62.1%). Fourteen of them (34.1%) were evaluated as having glaucomatous defect. IOP was regulated with medical treatment in 7 eyes (50%), however other 7 eyes required surgical intervention. There was no difference in between groups, regarding anterior segment reaction severity, number of attacks and recurrence rates (p=0.332, p=0.098, p=0.457; Mann Whitney U test). Presence of granulomatous KPs was more prevalent in Group 2 and corneal vascularization was higher in Group 3, significantly (p=0.041, p:0.003; chi-square test).Conclusion: Elevated IOP is considerably common (%62.1) in patients with herpetic anterior uveitis; however only quite a few of them (17.1%) requires surgery. Presence of granulomatous KPs was related with increased prevalence of OHT. As an indicator of disease severity and chronicity, corneal vascularization was related with increased glaucoma risk.Amaç: Herpetik ön üveitlerde göz içi basınç yüksekliğinin (GİB) sıklığını saptamak ve klinik özelliklerinin prognoza olan etkisini araştırmak.Gereç ve Yöntem: Herpetik ön üveit tanısı alan hastalara ait tıbbi kayıtlar retrospektif olarak incelendi. Hastalar GİB normal seyreden (Grup 1), oküler hipertansiyon (OHT) saptanan (Grup 2) ve glokom gelişenler (Grup 3) olmak üzere 3 gruba ayrıldı. Klinik sonuç ile klinik bulgular arasındaki ilişki araştırıldı. Bulgular: Altmış altı hastanın (32 kadın, 34 erkek) 66 gözü çalışmaya dahil edildi. Ortalama yaş 49.2±18.9 yıl, ortalama takip süresi 20.7±23.2 ay idi. İzlem sırasında 41 gözde (%62.1) GİB yüksekliği saptandı. Bunların 14 (%34.1)'ünde glokomatöz optik sinir defekti geliştiği görüldü. Yedi gözde (%50) GİB medikal tedavi ile kontrol altına alınırken 7 göze cerrahi uygulandı. Gruplar karşılaştırıldığında ön kamara reaksiyon şiddeti, atak sayısı, rekürrens sıklığı açısından farklılık göstermezken (p=0,332, p=0,098, p=0,457; Mann Whitney U test), granülomatöz keratik presipitatların (KP) varlığı OHT saptananlarda, korneal vaskülarizasyon gelişimi ise glokom gelişenlerde anlamlı yüksek bulundu (p=0.041, p:0.003; ki-kare testi).Sonuç: Herpetik ön üveitli hastalarda GİB yüksekliği oldukça sık (%62.1) olarak görülmekte ancak bunların az bir kısmı (%17.1) cerrahi girişim gerektirmektedir. Çalışmada klinik özellikler içerisinde granülomatöz KP varlığı oküler hipertansiyon sıklığında artış ile, korneal vaskülarizasyon varlığı ise hastalığın ciddiyeti ve uzun seyrinin bir göstergesi olarak artmış glokom riski ile ilişkili bulunmuştur

Is Blindness Close to Death?

The association between visual impairment and mortality has been reported in many studies. As well as some ocular diseases may be associated with increased mortality directly, visual impairment is also reportedly associated with many factors linked to higher risk of dying via indirect pathways. These include unintentional injury and increased risk of falls, reduced walking speed, lower body mass index, self-reported difficulty in physical activity and nutrition, cardiovascular diseases and even cancer, dementia, anxiety, depression, and reduced social interaction. Visual impairment also severely affect a person’s self-ranking of his or her health. Correction for these confounders has been found to attenuate the association between visual impairment and mortality, but the real mechanisms behind the association between visual impairment and mortality is still unclear. The impact of visual impairment on mortality with the decreased quality of life is an important health problem, and the ophthalmologists should be aware of it. In this review, we summarize all studies related to this subject in different patient populations. (Turk J Ophthalmol 2014; 44: 471-5