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Syntia Nusanti
Department of Ophthalmology, Universitas Indonesia
Health Professions Medicine & Pharmacology Public Health

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A Rare Case Report of Bilateral Traumatic Carotid Cavernous Fistula Rafika Sari Fadli; M Sidik; Syntia Nusanti
Majalah Oftalmologi Indonesia Vol 46 No 1 (2020): Ophthalmologica Indonesiana
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/journal.v46i1.100019

Abstract

Objective : To increase the awareness for ophthalmologist in diagnosing rare case of bilateral traumatic carotid cavernous fistula that could lead to serious complications. Case description : A 44 years old woman came with chief complaint of squint and diplopia since one month after traffic accident. She had been underwent orbital bone fracture repair at previous hospital immediately. There was complaint of headache, blurred vision, double vision and pain on the eyes one month after trauma. There was no history of redness or proptosis. Examination revealed 6/6 for the right and 6/8.5 for the left eye corrected visual acuity, 30 degrees exotropia, normal intraocular pressures (IOP), restriction on eyes movement especially on the left eye, normal anterior and posterior segment, and no bruit. CT orbital revealed bilateral dilated and tortuous of the ophthalmica vein with suspicious of carotid cavernous fistula (CCF). Patient developed slowly progressive conditions such as proptosis non axial on the left eye, redness with corkscrew appearance on both eyes, restriction of the ocular movement and also founded bruit on both eyes within two months follow up. CT angiography revealed CCF bilateral type A. Patient underwent digital subtraction angiography (DSA) and balloon embolization four months after diagnosed. Conclusion : Although bilateral carotid cavernous fistula is a rare case, performing a suitable diagnostic examination would help to prevent devastating outcome. Prognosis depends on severity and time span from symptoms to treatment.
Sudden Visual Impairment In Sellar Region Tumor: A Case Of Pituitary Apoplexy Anindita Wicitra; Syntia Nusanti; M Sidik
Majalah Oftalmologi Indonesia Vol 46 No 1 (2020): Ophthalmologica Indonesiana
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/journal.v46i1.100023

Abstract

Objective : Pituitary apoplexy described as an acute hemorrhagic infarction of the pituitary adenoma causing sudden increase of intra sellar pressure. This condition is a life-threatening disease. The purpose of this article is to report about clinical symptom and methods to diagnose pituitary apoplexy. Methods : A case presentation Result : A 40 y.o male came with a complain of blurry vision since 1 year. Two months before admission, he felt sudden worsening of his visual acuity. He went to private hospital and there was bleeding in his brain CT scan. His right eye visual acuity was 1/300 and his left best visual acuity was 6/12. Relative afferent pupillary defect was positive in the right eye. In funduscopic examination, both of optic nerve head were atrophy. Left eye visual field examination revealed temporal hemianopsia. Cerebral MRI showed a hyper intense lesion on both T1WI and T2WI sequence in sellar region that extends into supra sellar region with sign of sellar floor ballooning. The result of MRI contrast was relatively same and the hormonal exam result was within normal limit. Then he was scheduled for removal tumor surgery from neurosurgery departement. Conclusion : Pituitary apoplexy is a severe clinical syndrome and life-threatening disease. To rule out other disease presenting related symptoms, many ancillary examinations are require to be performed. The treatment of pituitary apoplexy, whether to treat surgically or conservatively, should be made by experts from a multidisciplinary team.
Endovascular Coiling Embolization in Direct Carotid Cavernous Fistula Yulika Harniza; Syntia Nusanti; Jacub Pandelaki
Majalah Oftalmologi Indonesia Vol 46 No 1 (2020): Ophthalmologica Indonesiana
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/journal.v46i1.100026

Abstract

Background: Carotid cavernous fistula (CCF) is a rare life-threatening. Rapid endovascular technical development has provided as a safe and effective treatment strategy for direct CCF (DCCF). Coiling treatment is a promising endovascular procedures solution in DCCF. Method: A comprehensive PubMed, Clinical key, and Ophthalmology database search was conducted using appropriate keywords (direct carotid cavernous fistula, endovascular treatment, embolization, and coil). Inclusion criteria was only article in English. Results: Nine studies (8 case series and 1 cohort study) were found suitable. From these results, endovascular coiling treatment can close the fistula with radiological evaluation and improvement in clinical symptoms in most of studies (90% and 88%, respectively). Post-operative and long-term complication were reported in some studies. Conclusion: Efficacy of endovascular coiling embolization appears promising in management of DCCF. There were no intra-operative complications and post-operative complications, such as unraveled micro-coil. The recurrence fistula rate of 4% is common in fistulas with larger tears associated with a larger CCF.
Co-Authors Anindita Wicitra M Sidik Pandelaki, Jacub Rafika Sari Fadli Yulika Harniza