OPTIC NERVE HEAD PERFUSION ON OCT ANGIOGRAPHY: TWO CASE REPORTS OF INTERNAL CAROTID ARTERY STENOSIS AND CAROTID–CAVERNOUS FISTULA
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Abstract
Purpose: To describe optic nerve head perfusion characteristics on optical coherence tomography angiography (OCTA) in two large-vessel disorders with different hemodynamic mechanisms: internal carotid artery stenosis and carotid-cavernous fistula.
Methods: This report describes two clinical cases examined with swept-source OCTA (DRI Triton, Topcon) using a 4.5 × 4.5 mm Angio Disc protocol. Vessel density in the disc center and peripapillary area was analyzed in the superficial, deep, and whole layers.
Results: In the patient with internal carotid artery stenosis, vessel density decreased in both the disc center and peripapillary region, particularly in the superficial layer, suggesting reduced inflow to the optic nerve head. In the patient with carotid-cavernous fistula, OCTA showed reduced disc-center vessel density together with heterogeneous peripapillary signals, consistent with complex hemodynamic disturbance related to arteriovenous shunting and venous congestion.
Conclusion: OCTA demonstrates distinct microvascular patterns in optic nerve head perfusion according to the underlying hemodynamic mechanism. It may serve as a useful non-invasive adjunct for diagnosis, follow-up, and post-intervention assessment.
Keywords
OCTA, optic nerve head, internal carotid artery stenosis, carotid-cavernous fistula, vessel density
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References
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