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Sunil Warrier, MBBS; Venkatesh C. Prabhakaran, MS, MRCOphth; Alejandra Valenzuela, MD; Tim J. Sullivan, FRANZCO; Garry Davis, FRANZCO; Dinesh Selva, FRANZCO

Arch Ophthalmol. 2008;126(12):1669-1675.

Objective  To present the clinical features, management, and outcomes in a series of patients with orbital arteriovenous malformations (AVMs).

Methods  Clinical records of patients with orbital AVMs confirmed using angiography were reviewed as a retrospective, noncomparative, interventional case series.

Results  Eight patients (3 women and 5 men) with unilateral AVMs and a mean age of 39 years (median, 36.5 years; range, 26-70 years) were reviewed. Findings existed for an average of 11.2 years before diagnosis and included periocular mass (7 patients, 88%); periocular edema, pulsation/bruit, proptosis, episcleral congestion, and previous trauma (4 patients each, 50%); elevated intraocular pressure (3 patients, 38%); pain and reduced visual acuity (2 patients each, 25%); and restriction of extraocular movements, and diplopia (1 patient each, 12%). All of the patients except 1 underwent surgical resection, with 3 (38%) receiving preoperative embolization of feeder vessels; all of the patients had initial resolution of manifestations after treatment.

Conclusions  Angiography is essential for diagnosis and for planning the management of orbital AVMs. Treatment depends on patient-specific features and includes observation, embolization, and surgical excision or combined preoperative embolization/excision. Given their vascular nature, the main cause of poor management outcomes is perioperative hemorrhage. Outcomes after a multidisciplinary approach are good, with few recurrences reported at follow-up.

Author Affiliations: South Australian Institute of Ophthalmology and Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia (Drs Warrier, Prabhakaran, Davis, and Selva); and Department of Ophthalmology, Royal Brisbane Hospital, Brisbane, Queensland (Drs Valenzuela and Sullivan), Australia.

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