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.