Abstract
Purpose :
Cavernous sinus thrombosis (CST) is a rare condition traditionally associated with high mortality and morbidity, though more recent publications report favorable outcomes including full functional recovery and lower mortality rates than previous literature. We performed a multi-centered retrospective, comparative clinical study to identify prognostic factors for visual and survival outcomes in CST.
Methods :
We conducted a comparative cohort study at two tertiary care centers through retrospective search of electronic medical records using ICD-9 and ICD-10 codes for orbital cellulitis and the term, “thrombosis of cavernous venous sinus.” Chart review identified those with radiographic evidence of CST. Patients were divided into two cohorts: CST with and CST without relative afferent pupillary defect (RAPD) at presentation. Primary outcome measures included visual outcome; defined by best-corrected visual acuity (BCVA) and extraocular motility (EoM) deficit at last follow-up; and same-hospitalization mortality. Secondary analyses included associations between visual or survival outcomes and presenting BCVA or comorbid orbital cellulitis. Multivariable logistic regression and Pearson’s χ2 test were conducted using STATA 16 (College Station, TX: StataCorp LLC).
Results :
Of the 30 CST patients identified, eight had an RAPD at presentation. The RAPD cohort had significantly worse BCVA at final evaluation (logMAR BCVA 1.43 higher on average, p = 0.01) and a significantly higher mortality rate (37.5% versus 0.0%, p < 0.01) than the non-RAPD cohort after accounting for time to follow-up. There was no difference in final EoM restriction between the two groups. Presenting BCVA and comorbid orbital cellulitis were not associated with worse visual or survival outcomes.
Conclusions :
While presenting BCVA and comorbid orbital cellulitis may not reliably predict visual or survival outcomes in CST, the presence of an RAPD at presentation may be a predictor of poor visual outcome and mortality in CST patients. Further investigation is warranted to identify potential outcomes-modifying interventions in this high-risk cohort.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.