Successful treatment of a serous retinal pigment epithelial detachment by coiling of a carotid-cavernous fistula.
OBJECTIVE
To report a patient presenting with a symptomatic retinal pigment epithelial detachment (RPED) that resolved after successful treatment of a slow flow dural carotid cavernous fistula (CCF). Possible pathophysiological mechanisms are discussed.


METHODS
Interventional case report.


RESULTS
A 69-year-old female presented with left uniocular distortion, confirmed on fluorescein and indocyanine green angiography to be secondary to a non-vascularised serous RPED. Further examination revealed a long standing left VI nerve palsy, mild proptosis and conjunctival injection. Magnetic resonance and cranial angiography confirmed the presence of a dural CCF. Surgical closure of the CCF resulted in a rapid resolution of the clinical signs and improvement in visual symptoms.


CONCLUSIONS
Patients with serous RPED and other signs or symptoms of a CCF may warrant neuroimaging of the orbit and/or angiography to evaluate for CCF, as correct diagnosis may lead to an excellent visual outcome.
From the *Department of Ophthalmology, Lincoln County Hospital, Lincoln, and the †Division of Ophthalmology and Visual Sciences, University of Nottingham, Eye, Ear, Nose and Throat Centre, Queen's Medical Centre, Nottingham, United Kingdom.
Paul E
PE
Tesha
Andrew C
AC
Browning
Ruby
R
Amankwah
Ameet A
AA
Shah
Andrew
A
Castillo
Winfried M
WM
Amoaku