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Gallo B, Khader R, Fajardo-Sanchez J, Sullivan P, Anikina E. Factors affecting anatomical and visual outcomes in Terson syndrome managed by surgery or observation. Eye (Lond) 2024:10.1038/s41433-024-03113-1. [PMID: 38740960 DOI: 10.1038/s41433-024-03113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/08/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES To investigate visual outcomes and prognostic factors of patients with Terson syndrome (TS) managed with observation or pars plana vitrectomy (PPV). METHODS retrospective review of medical records of 117 eyes from 81 patients (43 females) with TS. Main outcome measures were final best corrected visual acuity (BCVA), intraoperative findings and long-term sequelae. RESULTS 46 (39.3%) eyes were managed conservatively and 71 (60.7%) eyes underwent PPV. Median follow-up was 8.4 months. The PPV group had significantly worse (p < 0.001) baseline BCVA (median 2.3 versus 0.7 logMAR, Snellen equivalent 20/4000 versus 20/100). Final BCVA did not differ between the two groups (p = 0.38). Final BCVA ≥ 0.3 logMAR (20/40) in the surgery group was associated with post-operative retinal detachment (p = 0.013) and macular abnormalities (p = 0.014), and in the observation group with ocular comorbidity (p = 0.008). Retinal breaks were detected intraoperatively in 25 (35.2%) eyes and were associated with an interval longer than 3 months between ocular diagnosis and surgery (p = 0.04), but not with larger gauge instrumentation and posterior vitreous detachment. Incidence of ERM did not differ among patients managed conservatively and after PPV (p = 0.9) and between eyes undergoing early or delayed surgery (p = 0.09). The most common post-operative complications were cataract in 16 (22.5%) eyes and ERM in 8 (11.3%) eyes. CONCLUSIONS visual outcomes in TS are similar with both management strategies. Surgery allows faster and greater visual recovery but carries high risk of intraoperative retinal tears if delayed for longer than 3 months from initial presentation. ERM and retinal detachment are not correlated with timing of surgery or management strategy.
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Affiliation(s)
- Beatrice Gallo
- Royal Berkshire Hospitals NHS Foundation Trust, London Road, Reading, RG1 5AN, UK.
| | - Ramy Khader
- Royal Berkshire Hospitals NHS Foundation Trust, London Road, Reading, RG1 5AN, UK
| | | | - Paul Sullivan
- Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK
| | - Evgenia Anikina
- Royal Berkshire Hospitals NHS Foundation Trust, London Road, Reading, RG1 5AN, UK
- Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK
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Stevanovic M, Eliott D. Terson Syndrome: A Review of the Literature. Int Ophthalmol Clin 2024; 64:89-106. [PMID: 38525984 DOI: 10.1097/iio.0000000000000502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
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Aboulhosn R, Raju B, Jumah F, Majmundar N, Prenner J, Matin T, Roychowdhury S, Singla A, Khandelwal P, Nanda A, Gupta G. Terson's syndrome, the current concepts and management strategies: A review of literature. Clin Neurol Neurosurg 2021; 210:107008. [PMID: 34775364 DOI: 10.1016/j.clineuro.2021.107008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/03/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022]
Abstract
Terson's Syndrome describes intraocular hemorrhage secondary to an acutely raised intracranial pressure (ICP). Although Terson's Syndrome is common amongst patients with subarachnoid hemorrhage (SAH), it is underdiagnosed and often overlooked. This review discusses the current understanding of the etiopathogenesis, clinical features, and management of Terson's Syndrome and highlights the visual and prognostic implications to stress the importance of timely diagnosis and management. The origin of intraocular hemorrhage in Terson's Syndrome has been debated. A recognized theory suggests that an acutely raised ICP induces effusion of cerebrospinal fluid into the optic nerve sheath which dilates the retrobulbar aspect of the sheath in the orbit. Dilatation mechanically compresses the central retinal vein and retinochoroidal veins resulting in venous hypertension and rupture of thin retinal vessels. A commonly reported clinical feature is decreased visual acuity and blurred vision. These may be accompanied by symptoms of increased ICP including loss of consciousness and headache. Diagnosis is established using evidence from the clinical presentation, ophthalmoscopy, and, when required, imaging including B-mode ultrasound, CT, MRI, and fluorescein angiography. Terson's Syndrome is managed conservatively by observation for mild cases and with vitrectomy for bilateral cases and for patients whose hemorrhage has not spontaneously resolved after an observational period. Terson's Syndrome can be used as a prognostic indicator of morbidity and mortality in underlying pathology like SAH. Fundoscopy of patients with SAH, acutely raised ICP or visual disturbance with unknown etiology can help establish a timely Terson's Syndrome diagnosis. This may avoid the risk of permanent visual impairment.
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Affiliation(s)
- Rabii Aboulhosn
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Forester Hill, Aberdeen, UK
| | - Bharath Raju
- Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School & University, Hospital, New Brunswick, NJ, USA
| | - Fareed Jumah
- Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School & University, Hospital, New Brunswick, NJ, USA
| | - Neil Majmundar
- Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School & University, Hospital, New Brunswick, NJ, USA
| | - Jonathan Prenner
- Department of Ophthalmology, Rutgers, Robert Wood Johnson Medical School & University, Hospital, New Brunswick, NJ, USA
| | - Tariq Matin
- Department of Interventional Radiology, Narayana Superspecialty Hospital, Nathupur, Gurugram, Haryana 122002, India
| | - Sudipta Roychowdhury
- Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School & University, Hospital, New Brunswick, NJ, USA
| | - Amit Singla
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Priyank Khandelwal
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Anil Nanda
- Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School & University, Hospital, New Brunswick, NJ, USA
| | - Gaurav Gupta
- Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School & University, Hospital, New Brunswick, NJ, USA.
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Kang HM, Cho JM, Kim SY, Choi JH. Clinical characteristics of asymptomatic Terson syndrome in the patients with aneurysmal subarachnoid hemorrhage. Int J Ophthalmol 2020; 13:292-300. [PMID: 32090040 DOI: 10.18240/ijo.2020.02.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate clinical characteristics of asymptomatic Terson syndrome and its clinical impact in patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS This retrospective, interventional study included 31 patients with aneurysmal SAH, and the medical records were reviewed. In addition to baseline characteristics of the study population such as age, sex, and underlying medical history, multi-modal imaging analysis, including fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), were also reviewed. Glasgow Coma Scale (GCS), Hunt-Hess (HH) grade, and Fisher scale at the time of admission, and functional outcome by using modified Rankin Scale (mRS) at 6mo were compared. RESULTS Of the 31 patients, 10 patients (32.3%) were diagnosed with Terson syndrome. All the patients with Terson syndrome did not report visual symptoms at the time of ophthalmologic screening. FA showed microvascular changes of retinal capillaries and varying degrees of disc leakage. SD-OCT allowed intuitive anatomical localization of multi-layered retinal hemorrhages and assessment of ellipsoid zone integrity. The patients with Terson syndrome showed significantly worse GCS (P=0.047) and HH grade (P=0.025) than those without, except Ficher scale (P=0.385). There was no significant difference in the mRS (P=0.250) at 6mo. Among baseline factors, the HH grade was the only significant factor associated with Terson syndrome (B=1.079, P=0.016). CONCLUSION In our study, 32.3% of the patients have Terson syndrome without visual symptoms. The baseline HH grade is significantly correlated with Terson syndrome, and there is no significant difference in the functional outcome between the patients with and without Terson syndrome. Terson syndrome may develop without any visual symptoms as shown in our study, and ophthalmologic screening may be recommended to prevent further visual deterioration especially in the patients with poor HH grade at the time of aneurysmal SAH.
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Affiliation(s)
- Hae Min Kang
- Department of Ophthalmology, Catholic Kwandong University, International St. Mary's Hospital, Incheon 22711, Republic of Korea
| | - Jin Mo Cho
- Department of Neurosurgery, Catholic Kwandong University, International St. Mary's Hospital, Incheon 22711, Republic of Korea
| | - So Yeon Kim
- Department of Neurosurgery, Catholic Kwandong University, International St. Mary's Hospital, Incheon 22711, Republic of Korea
| | - Jeong Hoon Choi
- Department of Ophthalmology, Choikang Eye Clinic, Seoul 01110, Republic of Korea
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Liu X, Yang L, Cai W, Gao L, Li Y. Clinical features and visual prognostic indicators after vitrectomy for Terson syndrome. Eye (Lond) 2019; 34:650-656. [PMID: 31455901 DOI: 10.1038/s41433-019-0547-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 04/29/2019] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To determine clinical characteristics and identify factors associated with better visual outcomes in patients who had vitrectomy for vitreous haemorrhage (VH) associated with Terson syndrome (TS). METHODS The records of 48 patients (54 corresponding eyes) who underwent vitrectomy for VH associated with TS from January 2008 to December 2017 were retrospectively reviewed. The main outcome measure was the final postoperative visual acuity. RESULTS At the last visit, 34 eyes (63.0%) achieved a BCVA of 0.3 or better. Eyes associated with traumatic brain injury had a better visual outcome than those with primary intracerebral haemorrhage (P = 0.042). In the primary intracerebral haemorrhage group, patients with hypertension-induced intracranial haemorrhage (IH) showed poorer final visual acuities than the ruptured intracranial aneurysm group (P = 0.023). In the delayed vitrectomy group, epiretinal membrane and peripheral retina changes were more common (P < 0.05). However, the difference in final visual acuity between the early and delayed vitrectomy groups was not significant (P = 0.69). CONCLUSION Most of the patients obtained visual recovery after vitrectomy for TS. VH associated with ruptured intracranial aneurysm or traumatic brain injury or eyes without retinal haemorrhage are predictive of better prognosis. Although the timing of vitrectomy was not related to the final postoperative visual outcome, early vitrectomy by three months seems to suggest less epiretinal membrane formation, retinal tears, and retinal detachments.
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Affiliation(s)
- Xin Liu
- Eye Center, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China
| | - Longfei Yang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China
| | - Wenrui Cai
- Eye Center, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China
| | - Linlin Gao
- Eye Center, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China
| | - Yaping Li
- Eye Center, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China.
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Ramos-Estebanez C, Kohen M, Pace J, Bozorgi A, Manjila S, Alambyan V, Nwankwo I, DeGeorgia M, Bambakidis NC, Orge F. Bedside optical coherence tomography for Terson's syndrome screening in acute subarachnoid hemorrhage: a pilot study. J Neurosurg 2018; 130:517-524. [PMID: 29393753 DOI: 10.3171/2017.7.jns171302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/24/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Approximately 10% of patients with subarachnoid hemorrhage (SAH) become permanently, legally blind. The average cost of lifetime support and unpaid taxes for each blind person amounts to approximately $900,000. This study evaluates the feasibility and potential role of bedside optical coherence tomography (OCT) in Terson’s syndrome (TS) in patients with acute SAH (aSAH) and its potential role in blindness prevention. METHODS The authors conducted an open-label pilot study, in which 31 patients with an angiographic diagnosis of aSAH were first screened for TS with dilated funduscopy and then with OCT in the acute phase and at 6-week followup visits. Outpatient mood assessments (Patient Health Questionnaire–depression module, Hamilton Depression Scale), and quality of life general (NIH Patient-Reported Outcomes Measurement Information System) and visual scales (25-item National Eye Institute Visual Functioning Questionnaire) were measured at 1 and 6 weeks after discharge. Exclusion criteria included current or previous history of severe cataracts, severe diabetic retinopathy, severe macular degeneration, or glaucoma. RESULTS OCT identified 7 patients with TS, i.e., a 22.6% incidence in our aSAH sample: 7 in the acute phase, including a large retinal detachment that was initially missed by funduscopy and diagnosed by OCT in follow-up clinic. Dilated retinal funduscopy significantly failed to detect TS in 4 (57.1%) of these 7 cases. Intraventricular hemorrhage was significantly more common in TS cases (85.7% vs 25%). None of the participants experienced any complications from OCT examinations. Neither decreased quality of life visual scale scores nor a depressed mood correlated with objective OCT pathological findings at the 6-week follow-up after discharge. There were no significant mood differences between TS cases and controls. CONCLUSIONS OCT is the gold standard in retinal disease diagnosis. This pilot study shows that bedside OCT examination is feasible in aSAH. In this series, OCT was a safe procedure that enhanced TS detection by decreasing false-negative/inconclusive funduscopic examinations. It allows early diagnosis of macular holes and severe retinal detachments, which require acute surgical therapy to prevent legal blindness. In addition, OCT aids in ruling out potential false-positive visual deficits in individuals with a depressed mood at follow-up.
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Affiliation(s)
| | - Maryo Kohen
- 2Department of Ophthalmology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | | | | | - Faruk Orge
- 2Department of Ophthalmology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
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Mao X, You Z. 25G compared with 20G vitrectomy under Resight non-contact wide-angle lenses for Terson syndrome. Exp Ther Med 2017; 14:1193-1197. [PMID: 28810578 DOI: 10.3892/etm.2017.4592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 11/04/2016] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to compare the effectiveness of 25G vitrectomy to standard 20G vitrectomy for treatment of Terson syndrome under Resight non-contact wide-angle lenses. This was a case-control study of 20 patients with Terson syndrome (study group) that underwent 25G vitrectomy under Resight non-contact wide-angle lenses, with those of 20 matched patients that underwent 20G vitrectomy (control group). Medical records were reviewed from between July 2011 and October 2013. Data included results of the Early Treatment Diabetic Retinopathy Study examination, ophthalmology B-scan ultrasonography and fundus photography. The mean age, follow-up time, the preoperative visual acuity of LogMAR and the preoperative intraocular pressure (IOP) were all comparable in the two groups (all P>0.05). There were statistically significant differences in postoperative visual acuity of LogMAR compared with preoperative visual acuity (P<0.001) in both groups, but no difference between the groups (P=0.845). However, the operative times (13.5 min in study group vs. 42 min in control group) and post-operative IOP at day 1 (13.5 vs. 20 mmHg) were significantly reduced in the study group compared to the control group (P<0.001). Therefore, the present findings suggest that 25G Vitrectomy for Terson syndrome under Resight non-contact wide-angle lenses can achieve a significantly shorter operative time and lower post-operative IOP compared with 20G Vitrectomy.
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Affiliation(s)
- Xinbang Mao
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Zhipeng You
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
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Narayanan R, Taylor SC, Nayaka A, Deshpande R, St Aubin D, Hrisomalos FN, Hu J, Rajagopal R, Tewari A, Apte RS. Visual Outcomes after Vitrectomy for Terson Syndrome Secondary to Traumatic Brain Injury. Ophthalmology 2016; 124:118-122. [PMID: 27817917 DOI: 10.1016/j.ophtha.2016.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/31/2016] [Accepted: 09/12/2016] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To evaluate visual outcomes after vitrectomy for intraocular hemorrhages secondary to traumatic brain injury. DESIGN Retrospective, observational case series. PARTICIPANTS A total of 28 eyes in 20 patients undergoing vitrectomy for Terson syndrome secondary to traumatic brain injury between 1997 and 2015. METHODS We reviewed the records of patients undergoing a standard 20-gauge or 23-gauge pars plana vitrectomy for intraocular hemorrhages secondary to traumatic brain injury, and the timing of vitrectomy in relation to the inciting intracranial event was recorded. MAIN OUTCOME MEASURES The primary outcome measure was the change in the preoperative visual acuity score at postoperative month 1 and at the last noted clinic appointment. RESULTS A total of 28 eyes in 20 patients (all male) underwent pars plana vitrectomy for intraocular hemorrhages secondary to traumatic brain injury. The mean preoperative baseline logarithm of the minimum angle of resolution (logMAR) (Snellen) best-corrected visual acuity (BCVA) was 1.81±0.56 (20/1290). At 1-month postoperative follow-up, the mean BCVA was 0.30±0.33 (20/40). At the date of the last follow-up, the mean BCVA was 0.15±0.24 (20/30) and the median BCVA was 0.00 (20/20). Although the difference between preoperative and postoperative BVCA was significantly different at 1 month and the final postoperative clinic visits (P < 0.001), there was not a correlation between preoperative visual acuity as a predictor of final postoperative visual acuity outcome (r=-0.32; P = 0.09; 95% confidence interval [CI] -0.62 - 0.06). At the date of the last follow-up, the differences in visual outcomes between the individuals undergoing vitrectomy within 3 months of the inciting event, 0.08±0.15 (20/25), were not significantly different than those undergoing surgical intervention after 3 months, 0.18±0.27 (20/30) (P = 0.28). Three cases among those undergoing vitrectomy after 3 months were complicated by retinal detachment, none of which resulted in a BCVA worse than when the patient originally presented preoperatively. CONCLUSIONS In this retrospective series of patients without other ocular pathology, surgical intervention effectively provided rapid visual recovery in the majority of individuals with intraocular hemorrhages secondary to traumatic brain injury, irrespective of the timing of vitrectomy or of preoperative visual acuity.
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Affiliation(s)
| | - Stanford C Taylor
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri
| | | | | | - Daniel St Aubin
- Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan
| | - Frank N Hrisomalos
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Jonathan Hu
- Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan
| | - Rithwick Rajagopal
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Asheesh Tewari
- Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan
| | - Rajendra S Apte
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri.
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Gogneaux L, Marks C, Defoort Dhellemmes S. Traumatisme crânien grave : intérêt d’un examen ophtalmologique dans les premiers temps : cas d’un syndrome de Terson bilatéral. J Fr Ophtalmol 2016; 39:e213-e216. [DOI: 10.1016/j.jfo.2015.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/03/2015] [Accepted: 06/11/2015] [Indexed: 10/20/2022]
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Abstract
PURPOSE Terson's syndrome is a condition where a preretinal hemorrhage forms as a result of increased intracranial pressure. The elevated intracranial pressure is thought to be transmitted through the veins and the optic nerve sheath to the optic disc and retina, causing the thin capillary walls to rupture. The authors present a unique case of Terson's syndrome in a patient who underwent recent surgical management for cerebellar hemangioblastomas related to von Hippel-Lindau disease. CASE REPORT A 17-year-old African American female patient with a history of von Hippel-Lindau disease presented with pain in her right eye. She had recently undergone surgery to remove cerebellar hemangioblastomas. Preliminary fundus imaging was performed, but before formal ophthalmic testing could be conducted, the patient seized and was taken directly to the emergency room. When the patient returned for a formal evaluation 3 weeks later, a new preretinal "boat-shaped" hemorrhage was now present. Additionally, reports from the emergency room suggested that she had bled into the cavity where the previous cerebellar resection had taken place. This hemorrhage likely led to an increase in intracranial pressure, causing a Terson's-like event. CONCLUSIONS A Terson's event may be caused by high intracranial pressure secondary to the surgical removal of von Hippel-Lindau syndrome-associated cerebellar tumors and should be included as a possible complication of surgical management.
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Skevas C, Czorlich P, Knospe V, Stemplewitz B, Richard G, Westphal M, Regelsberger J, Wagenfeld L. Terson's Syndrome—Rate and Surgical Approach in Patients with Subarachnoid Hemorrhage. Ophthalmology 2014; 121:1628-33. [DOI: 10.1016/j.ophtha.2014.02.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 02/14/2014] [Accepted: 02/14/2014] [Indexed: 11/29/2022] Open
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Ko F, Knox DL. The Ocular Pathology of Terson's Syndrome. Ophthalmology 2010; 117:1423-9.e2. [DOI: 10.1016/j.ophtha.2009.11.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 11/18/2009] [Accepted: 11/18/2009] [Indexed: 02/08/2023] Open
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Errera MH, Barale PO, Ounnoughene Y, Puech M, Sahel JA. [25-Gauge transconjunctival vitrectomy in a case of bilateral epiretinal membrane associated with a Terson syndrome]. J Fr Ophtalmol 2009; 32:268-72. [PMID: 19769858 DOI: 10.1016/j.jfo.2008.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 12/18/2008] [Indexed: 11/29/2022]
Abstract
The formation of epiretinal membranes associated with proliferative vitreoretinopathy is known to be a complication of Terson syndrome. We report the first case of a 25-Gauge transconjunctival sutureless vitrectomy performed in one eye as treatment for an epiretinal membrane secondary to a case of Terson syndrome (most probably due to a history of subdural hematoma in childhood). Following a review of the current literature on the subject we report the physiopathologic mechanisms of Terson syndrome and the explanation for the proliferative vitreoretinopathy formation.
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Affiliation(s)
- M H Errera
- Service d'Ophtalmologie IV, CHNO des XV-XX, Paris, France.
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14
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Abstract
PURPOSE There is no general agreement on the best indication and timing of vitrectomy in patients suffering from Terson syndrome. Therefore, we reviewed our cases in order to assess factors interfering with the functional outcome and complication rates after vitrectomy. METHODS In this retrospective consecutive case series, the records from all patients undergoing vitrectomy for Terson syndrome between 1975 and 2005 were evaluated. RESULTS Thirty-seven patients (45 eyes) were identified, 36 of whom (44 corresponding eyes) were eligible. The best-corrected visual acuity (BCVA) at first and last presentation was 0.07 +/- 0.12 and 0.72 +/- 0.31, respectively. Thirty-five eyes (79.5%) achieved a postoperative BCVA of > or = 0.5; 26 (59.1%) eyes achieved a postoperative BCVA of > or = 0.8. Patients operated on within 90 days of vitreous haemorrhage achieved a better final BCVA than those with a longer latency (BCVA of 0.87 +/- 0.27 compared to 0.66 +/- 0.31; P = 0.03). Patients younger than 45 years of age achieved a better final BCVA than older patients (0.85 +/- 0.24 compared to 0.60 +/- 0.33; P = 0.006). Retinal detachment developed in four patients between 6 and 27 months after surgery. Seven patients (16%) required epiretinal membrane peeling and seven cataract surgery. CONCLUSION Ninety-eight per cent of our patients experienced a rapid and persisting visual recovery after removal of a vitreous haemorrhage caused by Terson syndrome. A shorter time between occurrence of vitreous haemorrhage and surgery as well as a younger patient age are predictive of a better outcome. Generally, the surgical risk is low, but complications (namely retinal detachment) may occur late after surgery.
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Lee SB, Kim SH, Kim JY. Full Thickness Macular Holes Associated with Terson Syndrome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.7.1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sung Bok Lee
- Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea
- Chungnam National University Research Institute for Medical Sciences, Daejeon, Korea
| | - Sang Hyuk Kim
- Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Jung Yeul Kim
- Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea
- Chungnam National University Research Institute for Medical Sciences, Daejeon, Korea
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Sohn HJ, Nam DH. Postoperative Visual Recovery and Complications of Vitrectomy in Terson's Syndrome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2007. [DOI: 10.3341/jkos.2007.48.9.1242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hee Jin Sohn
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Heun Nam
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
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17
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Affiliation(s)
- Alexander Rubowitz
- Retina Service, Department of Eye Care Services, Henry Ford Hospital, Detroit, Michigan, USA.
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Kase S, Saito W, Yokoi M, Yoshida K, Furudate N, Muramatsu M, Saito A, Kase M, Ohno S. Expression of glutamine synthetase and cell proliferation in human idiopathic epiretinal membrane. Br J Ophthalmol 2006; 90:96-8. [PMID: 16361676 PMCID: PMC1856891 DOI: 10.1136/bjo.2005.078394] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIM The mechanisms of the cellular origin and cell proliferation in the idiopathic epiretinal membrane (ERM) are unsolved. The aim of this study was to examine the expression of cell cycle related molecules and glutamine synthetase (GS), which is expressed in Müller cells and their processes, in ERM tissues. METHODS The ERMs were surgically removed using pars plana vitrectomy. Formalin fixed, paraffin embedded ERM tissues were analysed by immunohistochemistry with anti-cyclin D1, p27 (KIP1), proliferating cell nuclear antigen (PCNA), and GS antibodies. RESULTS The histopathological findings showed that all the ERMs consisted of oval or spindle mononuclear cells with thin collagen-like tissues. Immunoreactivity for GS was detected in collagen-like tissues of ERM, presenting a continuous, isodense pattern. GS immunopositive cells in all cases expressed PCNA in their nuclei. Nuclear immunoreactivity for cyclin D1 was noted in the ERM constituent cells, whereas p27 (KIP1) positive nuclei were not detected. CONCLUSION Cyclin D1 and PCNA were expressed in the idiopathic ERM, which was mainly derived from Müller cells and extensions of their processes.
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Affiliation(s)
- S Kase
- Department of Ophthalmology and Visual Sciences, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo 060-8638, Japan.
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Gicquel JJ, Bouhamida K, Dighiero P. Complications ophtalmologiques du « jeu du foulard » chez un enfant de 12 ans. J Fr Ophtalmol 2004; 27:1153-5. [PMID: 15687927 DOI: 10.1016/s0181-5512(04)96286-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To report a first case of Terson-like syndrome associated with asphyxiophilic practices in an adolescent. METHODS A 12-year-old boy was referred for decreased visual acuity in his right eye. His father had been diagnosed 3 weeks before with subarachnoidal hemorrhage. Fundus examination showed a dense preretinal hemorrhage in the right eye suggestive of Terson syndrome. RESULTS Angio-magnetic resonance imaging eliminated aneurysm and arteriovenous malformation from the diagnosis. After questioning the boy further, he reported that he had participated in the "scarf game", a very popular (but lethal) asphyxiophilic practice in middle school, some hours before he noticed a sharp drop in the visual acuity of his right eye. After 2 months of follow-up, he recovered 20/20 vision in his right eye. CONCLUSION Retinal hemorrhages are quite rare in children. When the cause is not clear (subarachnoidal hemorrhage, arteriovenous malformation, shaken baby syndrome), it must be determined whether the patient has participated in the asphyxiophilic "scarf game" in order to prevent its lethal consequences.
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Affiliation(s)
- J-J Gicquel
- Service d'Ophtalmologie, CHU de Poitiers, rue de la Milétrie, BP 577, 86021 Poitiers, France.
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Augsten R, Königsdörffer E, Strobel J. Surgical approach in terson syndrome: vitreous and retinal findings. Eur J Ophthalmol 2000; 10:293-6. [PMID: 11192836 DOI: 10.1177/112067210001000404] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report some interesting findings in patients with bilateral Terson syndrome. METHODS We describe six eyes from three patients with Terson syndrome. Pars plana vitrectomy was performed in one eye twelve weeks, and in four eyes six months after the acute event. In one eye blood was suddenly spontaneously absorbed after four months. RESULTS The four eyes operated six months after injury showed severe complications and final visual acuity was between light perception and 0.6. The eye with surgical attendance twelve weeks after the acute injury had an uneventful course, and final visual acuity was 0.7. CONCLUSIONS Because of severe ocular complications and with a view to early rehabilitation, vitrectomy has been recommended for eyes with bilateral Terson syndrome, without spontaneous blood resorption. Surgery should be performed in at least one eye not later than four to eight weeks after the acute injury.
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Affiliation(s)
- R Augsten
- Department of Ophthalmology, Friedrich Schiller University of Jena, Germany
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