目的：明确创伤后颈内动脉海绵窦瘘(CCF)患者视力预后的临床及眼底预测指标，并报告诊断延迟、血管造影闭塞率与视功能预后之间的关联。

方法：本回顾性病例系列研究纳入2024年1月至2025年10月期间经数字减影血管造影确诊的创伤后颈内动脉海绵窦瘘患者。全套眼科检查包括视力、眼压(IOP)、眼底镜检查、相对性传入性瞳孔障碍(RAPD)和色觉。对临床表现模式、眼底镜下表现及视觉预后进行系统记录和描述性分析。

结果：共纳入8例患者，男5例、女3例，平均年龄28.5±13.2 岁； 其中7例(88%)由机动车事故致伤。患者平均诊断延迟时间为2.6±1.6 mo，7例(88%)就诊时病程已超过6 wk，5例(63%)继发青光眼； 尽管均为单侧瘘管，仍有3例(38%)出现双侧体征与体征。瘘管分型以A型直接型CCF为主(7例，88%)。眼底镜下表现分为三类：视盘正常(2例，25%)、视盘水肿(3例，38%)、视神经萎缩(3例，38%)。仅3例(38%)实现血管造影下瘘口完全闭塞，但患者视力预后与基线眼底表现的相关性远高于瘘口闭塞程度。3例视神经萎缩患者视力预后差(末次视力从无光感至20/30)； 2例眼底无异常者视力恢复理想(末次视力达20/20至20/25)； 3例视盘水肿患者预后因疾病严重程度而异，从完全恢复到持续性视力丧失不等。1例患者行部分栓塞术后，对侧眼视力下降(从20/20降至20/150)。

结论：本研究中88%患者就诊时已超出6 wk关键治疗窗口期，在医疗资源有限地区，创伤后CCF的早期识别仍是一大挑战。患者视力预后主要由基线眼底镜所见相关，而非血管造影瘘口闭塞程度。已发生视神经萎缩的患者(38%)，无论手术是否成功，视功能恢复极为有限； 而视盘结构完好者预后更佳。在缺乏先进影像学检查手段的情况下，系统的神经眼科检查——尤其是RAPD检测和眼底镜检查——可实现早期诊断和预后评估。

METHODS: This retrospective case series reports patients with post-traumatic CCF confirmed by digital subtraction angiography between January 2024 and October 2025. Comprehensive ophthalmic evaluation included visual acuity, intraocular pressure(IOP), fundoscopy, relative afferent pupillary defect(RAPD), and color vision. Clinical presentation patterns, fundoscopic findings, and visual outcomes were systematically documented and analyzed descriptively.

RESULTS: Eight patients(5 males, 3 females, mean age 28.5±13.2 y)were included; 7 cases(88%)from motor vehicle accidents. Mean diagnostic delay was 2.6±1.6 mo; 7 cases(88%)presented beyond 6 wk. Secondary glaucoma developed in 5 cases(63%). Bilateral signs and symptoms occurred in 3 cases(38%)despite unilateral fistulas. Type A direct CCF predominated(7 cases, 88%). Fundoscopic examination revealed three presentations: normal disc(2 cases, 25%), optic disc edema(3 cases, 38%), and optic atrophy(3 cases, 38%). Despite complete angiographic closure in only 3 cases(38%), visual outcomes seemed more closely associated with baseline fundoscopic findings than closure rates. Patients with optic atrophy(n=3)demonstrated poor visual prognosis(final visual acuity ranging no light perception to 20/30), while those with normal fundus(n=2)achieved excellent recovery(final visual acuity 20/20-20/25). Patients with disc edema(n=3)showed variable outcomes depending on disease severity, ranging from complete recovery to persistent visual loss. One patient experienced contralateral visual decline(20/20 to 20/150)following partial embolization.

CONCLUSION: With 88% of patients presenting beyond the critical six-week therapeutic window, early recognition of post-traumatic CCF remains a major challenge in resource-limited settings. Visual outcomes corresponded with baseline fundoscopic findings rather than angiographic closure rates. Patients with established optic atrophy(38%)demonstrated minimal visual recovery regardless of treatment success, while those with preserved disc architecture achieved favorable outcomes. In settings where advanced imaging is unavailable, systematic neuro-ophthalmic examination—particularly RAPD testing and fundoscopy—enables both early diagnosis and prognostic assessment.