Ciliary Body/Iris Appositioning Producing Mechanical Pupillary Defects in Carotid-Cavernous Sinus Fistula: An Overlooked Pathophysiologic Mechanism

Repeatability and Reliability of Quantified Ultrasound Biomicroscopy Image Analysis of the Ciliary Body at the Pars Plicata

Most of the ciliary body and ciliary processes of the eye cannot be directly visualized in vivo because of the posterior location of the pars plicata to the posterior chamber and iris. However, ciliary anatomy can be effectively imaged using ultrasound biomicroscopy (UBM) by placing the probe close to the limbus, perpendicular to this structure. Previous studies measuring ciliary body parameters in meridian UBM images found that these parameters were measured with poor reliability and repeatability. This study evaluates the intra-observer reliability and inter-observer agreement of a standardized protocol for measuring six ciliary parameters in transverse or quadrant UBM images that capture an entire row of ciliary processes. All six ciliary parameters have high intra-observer reliability, with ciliary body thickness, ciliary process length and ciliary process density measurements being the most consistent for each observer. The coefficient of variation for each observer ranged from 1.4%-15%. Inter-observer agreement was also high for all six parameters, with an intra-class correlation coefficient >0.8. Utilizing transverse UBM images of the pars plicata allows for consistent quantitative analysis in control subjects.

Observation of fundus and optical coherence tomography angiography manifestations in carotid cavernous fistula patients

PURPOSE

This study aimed to investigate fundus and optical coherence tomography angiography (angio-OCT) manifestations in carotid cavernous fistula (CCF) patients.

METHODS

Nine eyes of 7 CCF patients diagnosed with digital subtraction angiography (DSA) were included in this study. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp, fundus, spectral-domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (angio-OCT) examination in the CCF patients and 10 normal controls were conducted. Subfoveal choroidal thickness (SFCT) and macular vascular density (VD) were measured and compared with the control group. SFCT and VD were also compared before and after embolization therapy.

RESULTS

Two male and 5 female CCF patients were included. The average age was 59.7 ±10.0 (years). Embolization therapy was conducted in 3 patients. Fundus manifestations included disc oedema and exudation, retinal venular dilation, and retinal haemorrhage. B-scan OCT examination revealed retinal and choroidal undulations, retinal-choroidal thickness, retinal cystoid oedema, and subretinal fluid. The SFCT of the affected eyes was thicker than that of the control group (412.3 ± 123.7 μm vs. 272.9 ± 62.9 μm; P = 0.006). Macular superficial capillary plexus (SCP) VD in affected eyes was lower than that in the control eyes (50.1 ±2.3 % vs. 52.7 ± 1.7 % ; P = 0.014). The SFCT was reduced, and the vessel density in the SCP was increased after embolization therapy.

CONCLUSION

We demonstrated decreased VD in CCF patients with specific fundus and OCT manifestations. The pathological changes were immediately reduced after embolization therapy. This preliminary observation provides a supplemental method for the diagnosis and pathophysiological examination of CCF patients.