Abstract
Orbital arteriovenous fistula (AVF) is a rare disease, and its standard therapeutic
strategy has not been established. A 70-year-old male consulted an ophthalmologist
due to a visual field defect in his left eye. Neurological findings showed visual
impairment but no symptoms such as exophthalmos, conjunctival congestion, or diplopia.
Magnetic resonance imaging showed marked dilation of the left superior ophthalmic
vein (SOV). Cerebral angiography revealed an AVF that was limited to the left orbit.
The feeder was a branch of the ophthalmic artery that originated from the first portion,
and the drainer was the SOV, which was meandering and significantly dilated. Since
the only symptom was visual impairment, the etiology was considered to be compression
of the optic nerve due to a dilated SOV rather than increased venous pressure. Transvenous
embolization via the facial vein was performed, and a visual field examination 1 week
after the operation revealed marked improvement. Orbital AVF that develops only with
visual impairment is extremely rare. As demonstrated with this case, coil embolization
for proper position and reduction of the venous pressure, which relieves compression
on the optic nerve, may be useful in improving the visual impairment.
Keywords
endovascular treatment - orbital arteriovenous fistula - superior ophthalmic vein
- transvenous embolization - visual impairment
