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Purpose <p>To evaluate carotid cavernous fistula (CCF) ocular manifestations and outcomes and analyze predictors for clinical recovery within a 1-year follow-up period.</p> Study design <p>Retrospective cohort study.</p> Methods <p>Patients diagnosed with CCF were included. Clinical characteristics, visual acuity (VA), and intraocular pressure (IOP) were reviewed at baseline and at 1, 3, 6, and 12 months after treatment.</p> Results <p>Of the 141 eyes with CCF (133 patients), 45 and 96 were direct and indirect CCF, respectively. The most common ocular manifestations for both fistula types were dilated episcleral vessels (90.8%) and proptosis (75.9%). Embolization was performed in 43 (95.6%) and 51 (53.1%) eyes with direct and indirect CCF, respectively. The complete recovery rate from both CCFs at 1-year postembolization was 73.9%, whilst the recovery rate from the indirect type at 1-year postconservation was 21.2%. Factors predicting complete recovery included symptom duration of ≤30 days for direct CCF (adjusted odd ratio [aOR] = 7.77, <i>P</i> = .003) and embolization for indirect CCF (aOR = 3.63, <i>P</i> = .012). Overall, the VA significantly improved at 6 months after sole embolization (<i>P</i> &lt;.05). Final good VA (≥20/40) and IOP (≤21 mm Hg) were attained in 64.0% and 96.9% of the cases, respectively. Initial VA of &gt;20/200 (aOR = 38.78, <i>P</i> &lt;.001) and age (aOR = 0.95, <i>P</i> &lt;.001) were significantly associated with good final visual outcomes in both CCF types.</p> Conclusion <p>Patients with CCF required long-term follow-up of clinical recovery. Visual acuity at initial presentation and age should be considered for visual outcome prediction. Prompt diagnosis of direct fistula within 1 month and early embolization of indirect CCF can prevent residual symptoms following treatment.</p>

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Long-term ocular outcomes and prognostic factors for clinical recovery in carotid cavernous fistulas: a retrospective single-center study of 141 eyes

  • 期刊论文

  • 发表日期：

    2026年1月8日

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  • Juthamat Witthayaweerasak,
  • Suwichaya Mukmonthein,
  • Nipat Aui-aree,
  • Orapan Aryasit,
  • Chatchawal Aramrat

摘要

Purpose

To evaluate carotid cavernous fistula (CCF) ocular manifestations and outcomes and analyze predictors for clinical recovery within a 1-year follow-up period.

Study design

Retrospective cohort study.

Methods

Patients diagnosed with CCF were included. Clinical characteristics, visual acuity (VA), and intraocular pressure (IOP) were reviewed at baseline and at 1, 3, 6, and 12 months after treatment.

Results

Of the 141 eyes with CCF (133 patients), 45 and 96 were direct and indirect CCF, respectively. The most common ocular manifestations for both fistula types were dilated episcleral vessels (90.8%) and proptosis (75.9%). Embolization was performed in 43 (95.6%) and 51 (53.1%) eyes with direct and indirect CCF, respectively. The complete recovery rate from both CCFs at 1-year postembolization was 73.9%, whilst the recovery rate from the indirect type at 1-year postconservation was 21.2%. Factors predicting complete recovery included symptom duration of ≤30 days for direct CCF (adjusted odd ratio [aOR] = 7.77, P = .003) and embolization for indirect CCF (aOR = 3.63, P = .012). Overall, the VA significantly improved at 6 months after sole embolization (P <.05). Final good VA (≥20/40) and IOP (≤21 mm Hg) were attained in 64.0% and 96.9% of the cases, respectively. Initial VA of >20/200 (aOR = 38.78, P <.001) and age (aOR = 0.95, P <.001) were significantly associated with good final visual outcomes in both CCF types.

Conclusion

Patients with CCF required long-term follow-up of clinical recovery. Visual acuity at initial presentation and age should be considered for visual outcome prediction. Prompt diagnosis of direct fistula within 1 month and early embolization of indirect CCF can prevent residual symptoms following treatment.