Abstract:AIM: To identify clinical and fundoscopic predictors of visual outcomes in post-traumatic carotid-cavernous fistula(CCF)and report the relationship between diagnostic delay, angiographic closure rates, and functional prognosis.
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.
