title: Pressure-Lowering Effect of Fistula Occlusion in a Patient with Secondary Glaucoma Due to an Intracranial Arteriovenous Fistula.
abstract: BACKGROUND
  This case report presents the pressure-lowering effect of transluminal fistula occlusion in a patient suffering from secondary glaucoma due to carotid cavernous fistula (CCF).
  
  
  METHODS
  A 76-year-old Caucasian woman presented with dilated epibulbar vessels with elevated intraocular pressure (IOP, >30 mmHg) as well as glaucomatous excavations of the optic disc in both eyes. Cerebral digital subtraction angiography revealed a CCF with bilateral orbital communication. Preoperative diurnal pressure profiling showed an average IOP of 25.8 mmHg (right eye) and 26.6 mmHg (left eye). Transluminal intervention and fistula occlusion led to a decrease in IOP of about 9 mmHg. A post-operative oculomotor nerve palsy regressed spontaneously.
  
  
  CONCLUSIONS
  Secondary glaucoma due to CCF might be affected by fistula occlusion. Therefore, it should be considered before any surgical glaucoma interventions are performed. Diurnal pressure profiling is an effective tool for monitoring therapeutic success.
authors.affiliation: Department of Ophthalmology, University Hospital of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. jens.heichel@uk-halle.de.
authors.forename: Jens
authors.initials: J
authors.lastname: Heichel
authors.affiliation: Department of Ophthalmology, University Hospital of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hammer
authors.affiliation: Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Solymosi
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
authors.forename: Silvio
authors.initials: S
authors.lastname: Brandt
authors.affiliation: Department of Ophthalmology, University Hospital of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
authors.forename: Iris
authors.initials: I
authors.lastname: Winter
keywords: Carotid cavernous fistula; Diurnal pressure monitoring; Embolization therapy; Secondary glaucoma