Retinal arterial–venous pulse delay: a new specific marker for a carotid–cavernous fistula

• DOI: 10.3389/fopht.2023.1301410
• Publication Date: 2023-12-11T04:31:12Z
• Authors: Edward F. Linton; Thomas R. Tedeschi; Noor-Us-Sabah Ahmad; Jui-Kai Wang; Randy H. Kardon
• Keywords: Central retinal vein; Venule; Central retinal artery

Purpose The purpose of the study was to describe ocular blood flow changes in eyes affected by a carotid–cavernous fistula (CCF) using laser speckle flowgraphy. We hypothesized that imaging velocity waveforms retinal arterioles and venules simultaneously would reveal specific characteristics an arteriovenous (AV) connection. Design observational case series, with retrospective case–control analysis. Methods Five patients CCF underwent measurement compared retrospectively between control group healthy subjects ( n = 32) elevated intraocular pressure or venous outflow impairment without AV 40). outcomes were derived from arteriole venule waveforms, including A–V phase delay pulsatility. Results presence active associated increased peak measured (10.7% ± 2.2% cardiac cycle duration) unaffected fellow (1.8% 0.2%; p 0.05) normal (2.7% 0.3%; 0.02). This disappeared after thrombosis not present central vein occlusion (CRVO), glaucoma, non-arteritic anterior ischemic optic neuropathy (NAION), papilledema. decreased during systole (and some cases momentarily stopped), leading delayed pulse greater amplitude than controls normalizing (1.71 0.3 vs 0.54 0.03 0.59 0.02; 8.0E-12). could also be identified scanning ophthalmoscope (SLO; SPECTRALIS®) video. Conclusion Laser flowgraphy reveals dynamic vascular CCF, which are other eye conditions, reverses treatment.