Bedside optical coherence tomography for Terson’s syndrome screening in acute subarachnoid hemorrhage: a pilot study

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 follow-up 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.

Terson Syndrome in Patients with Aneurysmal Subarachnoid Hemorrhage: A 10-Year Single-Center Experience

“…The gold standard for the screening of TS is direct and indirect funduscopy by an ophthalmologist [11,15]. However, various studies have shown that TS can also be diagnosed using ocular ultrasound (OU) and cCT [12,[16][17][18][19][20].…”

Terson Syndrome: A Review of the Literature

“…In this study, 31 patients with subarachnoid hemorrhage received both OCT scans with the Optovue iVue SD-OCT and dilated fundus examination. 3 OCT identified Terson syndrome in 7 patients (22.6%), whereas fundoscopy identified Terson syndrome in only 3 patients. 3 It is important to note that the small intraocular hemorrhages that were missed by indirect fundoscopy may not be clinically relevant and would be unlikely to require surgical intervention.…”

“…3 OCT identified Terson syndrome in 7 patients (22.6%), whereas fundoscopy identified Terson syndrome in only 3 patients. 3 It is important to note that the small intraocular hemorrhages that were missed by indirect fundoscopy may not be clinically relevant and would be unlikely to require surgical intervention. Bedside OCT seems to be a promising tool for the diagnosis of Terson syndrome.…”

“…Terson syndrome is most frequently associated with subarachnoid hemorrhage and is diagnosed in approximately 20% of patients with aneurysmal subarachnoid hemorrhage 3–9 . Terson syndrome has been attributed to other etiologies such as traumatic brain injury, subdural hematoma, intraparenchymal hemorrhage, and extradural hematomas 9–14 .…”

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Terson syndrome is most frequently associated with subarachnoid hemorrhage and is diagnosed in approximately 20% of patients with aneurysmal subarachnoid hemorrhage. [3][4][5][6][7][8][9] Terson syndrome has been attributed to other etiologies such as traumatic brain injury, subdural hematoma, intraparenchymal hemorrhage, and extradural hematomas. 9-14 A prospective study of patients with intracerebral hemorrhage and traumatic brain injury found the rate of Terson syndrome to be 9.1% and 3.1%, respectively.

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