Chorio-Retinal Folds Associated With Orbital Cavernous Venous Malformations

Abstract

Purpose: To determine the incidence of clinically detectable chorio-retinal folds (CRFs) with orbital cavernous venous malformations (OCVMs) and their recovery. Methods: Retrospective case-note and imaging review, with estimation of odds ratios in relation to the position and volume of the mass. Results: Records for 402 patients were reviewed, 83 (21%) having CRFs. The mean logarithm of minimum angle of resolution acuity was similar with or without CRFs (0.37 and 0.31, respectively; p = 0.46), but induced hyperopia was commoner with CRFs (76% vs. 12%; p < 0.001), exophthalmos greater (4.52 mm vs. 2.97 mm; p < 0.001), eye movement restriction commoner (37% vs. 21%; p = 0.004), and disc swelling more prevalent (42%, vs. 17%; p < 0.001). Orbital cavernous venous malformations with CRFs were almost all intraconal (98%; odds ratio 9.96; p = 0.002), and 93% (77/83) midorbital (odds ratio 6.02; p < 0.001). The median size with CRFs was twice that of those without (3.85 ml vs. 1.92 ml; p < 0.001), and two-thirds OCVMs with folds had volumes >2.5 ml (p < 0.001). The OCVM was excised in 76 of 83 (92%) of CRF group and 213 of 319 (67%) of those without (p < 0.001). The postoperative acuity was improved or unchanged in 67 of 76 (88%) eyes with folds, and 184 of 213 (83%) without CRFs (p = 0.84). The proportion recovering an acuity within 1 Snellen line (or better than) the unaffected side was 80% with CRFs and 77% in their absence (p = 0.63). Induced hyperopia persisted in 39% of all patients, with the mean being higher with CRFs (2.22D vs. 1.02D; p = 0.017). Conclusions: CRFs occur in ~25% of mid-intraconal OCVMs. Despite OCVM excision, 39% of operated patients retain significant residual hyperopia (54% if CRFs present before surgery), and 41% of such CRFs remain clinically detectable after surgery (with variable visual impairment). Earlier surgery might, therefore, be advisable in patients with CRFs and/or induced hyperopia.