Posters

Final visual outcomes after early vitrectomy in Terson syndrome

Poster Details

First Author: M.Martinez Hergueta SPAIN

Co Author(s):    A. Ceausescu   M. Martínez Rubio                 

Abstract Details

Purpose:

Terson syndrome is described as any intraocular hemorrhage in the setting of intracranial hemorrhage. The Terson syndrome can be complicated especially when the evolution of the hemorrhage is superior to 4 weeks with epiretinal membranes, macular hole, retinal detachment, macular detachments and optic atrophy. Our principal objective is to report that early vitrectomy prevents these complications and allows a rapid improvement of visual acuity.

Setting:

Department of Ophthalmology. Alicante General University Hospital. Spain.

Methods:

We present a total of 4 eyes of 3 patients with diagnosis of Terson syndrome in the context of a spontaneous subarachnoid hemorrhage of aneurysmal origin.  All of them presented at the beginning a best corrected visual acuity (BCVA) of no more than perception of light. The fundoscopic examination showed an organized vitreous hemorrhage with abundant fibrin in all of them. We decided to perform an early pars plana vitrectomy 23G between weeks 6 and 8 of the diagnosis.

Results:

At 24 hours after surgery, all patients showed a best corrected visual acuity (BCVA) improvement greater than 20/40 on the snellen scale. After one month of intervention, patients recovered a BCVA higher than 20/32 and one of them gets a BCVA of 20/20. Only 1 eye presented a subretinal exudate in the inferior temporal arch after one month of the vitrectomy, the rest of the patients did not present alterations in the posterior pole. At 3 months after surgery, no patient developed epiretinal membranes secondary to the hemorrhage.

Conclusions:

The presence of Terson syndrome is indicative of the severity of the intracranial hemorrhage. Vitreous hemorrhage is the least frequent (3% of patients). The diagnosis can be difficult in a patient with an intracranial hemorrhage due to the loss of communication capacity and cognitive deterioration. Early diagnosis helps faster visual rehabilitation. There is some controversy regarding the optimal moment for surgery, but early vitrectomy can be considered in cases of bilateral involvement or dense hemorrhage to avoid complications and provide a rapid improvement of visual acuity.

Financial Disclosure:

None