Clinical observations and considerations in the treatment of Terson syndrome using 23G vitrectomy
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ORIGINAL PAPER
Clinical observations and considerations in the treatment of Terson syndrome using 23G vitrectomy Chengqun Ju . Shanshan Li . Chao Huang . Ying Li . Hong kyungwan . Fang Zhou . Jianqiao Li
Received: 12 June 2019 / Accepted: 24 April 2020 Ó Springer Nature B.V. 2020
Abstract Purpose This retrospective study analyzed the results of 23G vitrectomy for the treatment of intraocular hemorrhage in patients with Terson syndrome. The pathogenesis of Terson syndrome and the timing of vitrectomy are discussed. Methods Eight eyes of eight patients were included in the study. Intrasurgical images were acquired, and membranes peeled off during surgery were subjected to pathological staining. Postoperative examination included visual acuity, intraocular pressure, funduscopy, and optical coherence tomography angiography. Results The course of visual impairment in the patients ranged from \ 1 to 5 months; visual acuity ranged from light perception to 20/1000. Surgeries in the eight patients were all successful, and no severe complications were observed. Visual acuity improved in each operative eye. Pathological staining revealed
only fibrous connective tissue, and no nerve fibers in the membranes peeled off during surgery. Optical coherence tomography angiography revealed no changes in blood vessel density in the inner layer of the retina of the operative eye compared with the nonoperative eye in each patient. Conclusions Timely surgical intervention is necessary for the treatment of intraocular hemorrhage in patients with Terson syndrome. Clinical findings support the theory that intraocular blood results from stasis or rupture of retinal superficial peripapillary vessels caused by elevated intracranial pressure. Keywords Eye hemorrhage Intracranial hemorrhage Terson syndrome Vitrectomy
Introduction C. Ju S. Li C. Huang F. Zhou J. Li (&) Department of Ophthalmology, Qilu Hospital of Shandong University, Wenhua Xi Road107, Jinan 250012, Shandong, People’s Republic of China e-mail: [email protected] Y. Li Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan 250012, Shandong, People’s Republic of China H. kyungwan School of Medicine, Shandong University, Jinan 250012, Shandong, People’s Republic of China
In 1881, Litten first described vitreous bleeding occurring in association with subarachnoid hemorrhage [1]; however, the French ophthalmologist Albert Terson is credited with discovering this clinical sign in a patient with subarachnoid hemorrhage in 1900 [2]. Terson syndrome is now defined as intraocular hemorrhage (intravitreal, sub-internal limiting membrane and sub-retinal) arising from a sudden increase in intracranial pressure (ICP), which occurs in 10–20% of patients who experience subarachnoid hemorrhage (SAH) [3, 4]. Although the pathogenesis
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of Terson syndrome has not been fully explained, two theories are generally accepted: blood diffusing directly into vitreous cavity through the optic disc
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