PMC9441774_01
(A) When looking to the upper right, limitation of abduction of the right eye. (B) When looking to the right, the right eye showed no movement. (C) When looking to the lower right, limitation of abduction of the right eye.
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F1
Extraocular movements of the left eye were normal (Figure 1).
(A) More severe proptosis of the left eye with progressed exophthalmos compared to Figure 1. (B) Congested conjunctiva around 360 degrees of the left eye. (C) Corkscrew vessels on the conjunctiva (black arrows).
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F2
Unfortunately, 2 weeks later, the patient suffered from left eye ophthalmoplegia (Figure 2) with elevated IOP.
(A,B) Engorged left superior ophthalmic vein (red circle) in magnetic resonance imaging (A), magnetic resonance angiography (B), which confirmed carotid- cavernous sinus fistula. [(A) T2-weighted-Fluid-Attenuated Inversion Recovery, transverse view; (B) magnetic resonance angiography]. (C) Coronal view of magnetic resonance imaging revealed prominent engorged superior ophthalmic vein (red circle) [T2- Turbo spin echo (TSE) imaging, coronal view].
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F3
MRA revealed an engorged left superior ophthalmic vein and dilatation of bilateral cavernous sinuses, which favored the diagnosis of CCF (Figure 3).
(A) Color fundus photography demonstrated serous retinal detachment at the nasal and temporal arcade (white arrowheads). (B,C) Optical computed topography revealed subretinal fluid (red stars). (D) FA demonstrated tortuous retinal veins over branch retinal vessels (red arrows) and diffused macular dye leakage (red circle). (E) Peripheral retinal ischemic syndrome was observed by FA (red circle) with non-perfused peripheral retina.
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F4
Fundus photography of the left eye revealed serous retinal detachment, retinal vein tortuosity and mild choroidal detachment throughout the periphery (Figure 4).
Repeated catheter angiography. (A) Leakage from internal carotid artery (white arrow) was observed. (B) No more leakage after repeated coil embolization.
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F5
A repeat catheter angiogram revealed insufficient coil compaction with a leak in ICA which failed to achieve complete fistula obliteration (Figure 5).
Timeline of important visual acuity change. BCVA, best-corrected visual acuity; RD, retinal detachment; FRP, focal retinal photocoagulation; ME, macular edema; TAE, transarterial embolization.
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F6
The timeline of the patient's clinical course is shown in Figure 6.