Carotid cavernous fistula masquerading as delayed suprachoroidal hemorrhage after trabeculectomy

Abstract

Objective: Carotid cavernous fistulae (CCFs) are abnormal communications between the cavernous sinus and the carotid arterial system. Based on the etiology, CCFs can be traumatic, spontaneous and rarely iatrogenic. We report an interesting case of new onset CCF associated with shallow choroidal detachment after trabeculectomy surgery.

Method: Observational case report

Result: A 69-year-old male patient presented with complain of proptosis, congestion, and gross diminution of vision in the left eye following trabeculectomy elsewhere. Delayed suprachoroidal hemorrhage was diagnosed by the primary physician and the patient was on oral steroids. On USG-B scan, choroidal detachment and a dilated superior ophthalmic vein were seen. A digital subtraction angiogram showed type D CCF. In view of nil visual prognosis, he was treated conservatively and was referred to a neuroradiologist for further management.

Conclusion: CCFs have been rarely reported after intraocular surgeries. Till date, there is one case report of CCF complicating cataract surgery. Interestingly, CCFs has not been reported complicating trabeculectomy surgery. Dural CCFs although uncommon should be considered a close differential of hemorrhagic choroidal detachment, a relatively common complication following intraocular surgery.