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Journal List > J Korean Ophthalmol Soc > v.48(9) > 1007923

Sohn and Nam: Postoperative Visual Recovery and Complications of Vitrectomy in Terson's Syndrome

Abstract

Purpose

To investigate the visual recovery and complications of vitrectomy in Terson's syndrome.

Methods

A retrospective study was carried out on 11 eyes in 9 patients who had undergone pars plana vitrectomy for Terson's syndrome from October 2004 to June 2006. The factors assessed were age, gender, presence of hypertension, type of intracranial hemorrhage, preoperative and final visual acuity, time interval from intracranial hemorrhage (ICH) to vitrectomy, and any intraoperative and postoperative complications.

Results

The average age of the subjects and the Interval from ICH to vitrectomy were 43.0±11.0 years and 3.25±3.48 months respectively. Binocular involvement was found in two of the nine patients, and fundus findings were severe vitreous opacity in all cases, while sub-ILM hemorrhage at the posterior pole was seen in five eyes. Intraoperative retinal break was recorded at the 10 o'clock sclerotomy site in five eyes, and four of these five eyes were associated with sub-ILM hemorrhage. One patient underwent a scleral buckling operation four months postoperatively due to rhegmatogenous retinal detachment associated with a retinal tear at the 2 o'clock sclerotomy site. Visual acuity improved in all cases postoperatively, and the final visual acuity was over 0.6 in seven eyes.

Conclusions

We can expect from early surgery a relatively good prognosis of visual acuity and prevention of complications. Due to the possibility of retinal breaks at the sclerotomy sites, we should keep in mind that cautious handling of intraocular instrument and complete removal of vitreous base may be necessary.

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References

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jkos-48-1242f1.tif
Figure 1.
(A) The discrete Large dome-shaped subinternal limiting membrane hemorrhage in the posterior pole (B) Internal limiting membrane was peeled off with the microforceps at an area of subinternal limiting membrane hemorrhage using indocyanine green.
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Table 1.
Baseline patient data
Case Gender Age(years) Locality Hypertension Type of intracranial hemorrhage Interval from ICH to Vitrectomy
1 M 44 Right N SAH 4 mo
2 M 33 Right N SDH 1 mo
3a M 33 Bilateral:Right Y SAH 3 wk
3b M 33 Bilateral:Left Y SAH 3 wk
4 M 44 Left Y SAH 2 mo
5 F 46 Left Y SAH 3 wk
6 F 73 Left Y SAH 10 mo
7 M 42 Left N SAH 1 mo
8 F 37 Right Y SDH 7 mo
9a F 44 Bilateral:Right Y SAH 2 mo
9b F 44 Bilateral:Left Y SAH 9 mo

SAH: Subarachnoid hemprrhage, SDH: Subdural hemorrhage, ICH: Intracranial hemorrhage, N:no, Y:yes.

Table 2.
Clinical data
Study No. Eyes Intraoperative tear Postoperative retinal detachment
Terson's syndrome
Murijaneh, 2006 11 5 (45.5%) 3 (27.3%)
Guanaraj, 2000 25 5 (20%) 0 (0%)
Ritland, 2002 17 2 (28.6%) 5 (29.4%)
Kuhn, 1998 33 0 (0%) 2 (7.4%)
This study, 2006 11 5 (45.5%) 1 (9.1%)
Nondiabetic vitreous hemorrhage
Oyakawa, 1983 56 2 (3.6%) 0 (0%)
Isernhagen, 1988 49 5 (10.2%) 4 (8.2%)

HM: hand motion, CF: count fingers, PVD: posterior vitreous detachment, ILM: internal limiting membrane, RD: retinal detachment, Phaco c PCL: phacoemulsification with PCL implantation, IIOP: Increased intraocular pressure.

Table 3.
Surgical outcome post-vitrectomy for Terson's syndrome and nondiabetic vitreous hemorrhage
Case Visual acuity
Intraoperative Details Additional procedures Comments Follow up (months)
Postoperative Preoperative (Final)
Incomplete PVD Buckling
1 HM 0.4 Sub-ILM hemorrhage Cryotherapy 4
Tear (10 o'clock) ILM peeling Endolaser C3F8
Incomplete PVD Buckling Tear (2 o'clock)
2 HM 0.9 Subhyaloid hemorrhage Cryotherapy Postoperative RD
Sub-ILM hemorrhage ILM peeling : Scleral buckling, C3F8
Tear (10 o'clock) Sub-ILM hemorrhage Buckling
3a HM 0.6 Tear (10 o'clock) Cryotherapy 11
Marcular edema ILM peeling Endolaser
Sub-ILM hemorrhage Buckling Shallow focal RD
3b HM 0.3 Tear (10 o'clock) Cryotherapy IIOP 11
Focal RD ILM peeling Endolaser Marcular edema
4 HM 1.0 Tear (10 o'clock) Cryotherapy Cataract development 13
Focal RD Endolaser
5 HM 0.6 Superonasal degeneration Prophylactic Cryotherapy ILM peeling 4
6 CF 1.0 Superonasal degeneration Prophylactic Cryotherapy Phaco c PCL 5
7 CF 0.4 Sub-ILM hemorrhage Disc hemorrhage ILM peeling Endolaser 4
8 CF 0.2 ILM peeling Endolaser Severe NPDR High Myopia 7
9a HM 0.8 Cataract development 23
9b HM 0.8 Endolaser Phaco c PCL 16
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