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Neurotrophic keratitis ( NK ) in carotid cavernous fistulae ( CCF )
Author(s) -
Stephan S.,
Rouger H.,
Doan S.,
Lamirel C.,
Cochereau I.,
Gabison E.
Publication year - 2015
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2015.0618
Subject(s) - medicine , cavernous sinus , trigeminal nerve , in vivo , pathology , surgery , biology , microbiology and biotechnology
Purpose Carotid cavernous fistulae ( CCF ) are rare, with a poor visual outcome. In addition, lesions of trigeminal nerve induced by an elevated venous pressure in the cavernous sinus may induce a neurotrophic keratitis ( NK ). Embolization is the standard care. The objective of this study was to assess NK in a group of patients treated by embolization of their CCF using in vivo confocal microscopy. Methods Patients treated for an indirect CCF from January 2004 to May 2013 were prospectively included. The diagnostic of NK was assessed by Oxford's test, Cochet‐Bonnet's esthesiometry and a study of corneal nerves by in vivo confocal microscopy. Results were compared using Student t‐test. Results 13 patients, 5 men and 8 women, with a median age of 67 years old were included with a median follow‐up of 51 months: 38% (5/13) had a NK , of which 40% (2/5) bilateral. 60% (3/5) were clinically cured, with a minimal to moderate NK ; and 40% (2/5) had persisting CCF symptoms with a moderate to severe NK . Conclusions To our knowledge, NK resulting of a compression of the trigeminal nerve by CCF has never been studied. On the other hand, NK is a challenging diagnosis because of a poor clinical presentation. Recently, in vivo confocal microscopy has been developed for corneal nerves analysis and should therefore be considered as an interesting tool to assess NK in patients treated for a CCF . NK are frequent (38%) in patients treated for CCF . NK are minime to moderate and sometimes bilateral. Early diagnosis using in vivo confocal microscopy should avoid corneal complication.