Clinical features and visual prognostic indicators after vitrectomy for Terson syndrome

Liu, Xin; Yang, Longfei; Cai, Wenrui; Gao, Linlin; Li, Yaping

doi:10.1038/s41433-019-0547-3

Cited by 15 publications

(20 citation statements)

References 28 publications

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“…Although RD had a poor prognosis, successful anatomic reattachment of the retina was achieved in this series as reported before. [18][19][20] Twelve (66.7%) of the 18 eyes with delayed RD had VH at presentation. VH is considered to correlate with increased likelihood of RD and PVR after OGI.…”

Section: Discussionmentioning

confidence: 99%

Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy

Liu

Wang

Yang

et al. 2021

European Journal of Ophthalmology

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Purpose: To describe surgical management and establish visual outcomes of open globe injury (OGI) in pediatric patients requiring vitrectomy. Methods: Forty-eight eyes of 48 pediatric patients underwent vitrectomy for OGI with secondary vitreoretinal complications in the eye center of Jilin University were included. Characteristics of patients, details of ocular examination and operation, presenting and final visual acuity were recorded. Results: Presenting visual acuity less than 20/400 was found in 44 eyes (91.7%), which included no light perception (NLP) in four eyes. At last visit, there was no eyes with visual acuity of NLP, and 19 eyes (39.6%) had a vision recovery to 20/400 or better. Mechanisms of injury, intraocular contents prolapse, presence of hyphema, intraocular foreign body, vitreous hemorrhage, retinal detachment, and total time from injury to PPV > 2 weeks were significant predictors of visual prognosis. Logistic regression analysis showed that hyphema was a significant predictive factor for poor visual outcome. Conclusion: Visual acuity was improved in most of the patients with OGI in this study. Hyphema is an important presenting ocular sign in estimating the post-vitrectomy visual outcome for OGI in children. Proper timing of vitrectomy is suggested, and in this study patients may benefit more with early vitrectomy as less proliferative vitreoretinopathy (PVR) was found together with a better visual acuity.

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Section: Discussionmentioning

confidence: 99%

Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy

Liu

Wang

Yang

et al. 2021

European Journal of Ophthalmology

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“…La mayoría de los pacientes con síndrome de Terson se recuperan sin necesidad de cirugía, un estudio en Corea del Sur reportó que el 62,8 % de los pacientes presentaban mejoría con manejo medico expectante (observación) y solo al 36,2 % se les realizó vitrectomía vía pars plana 18 . La vitrectomía vía pars plana es recomendada entre la sexta y decimosegunda semana posterior a la pobre resolución de una hemorragia vítrea [19][20][21] .…”

Section: Discussionunclassified

Glaucoma de células fantasmas secundario a Síndrome de Terson en un ojo fáquico

Rivas

2021

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Paciente masculino con antecedente de trauma craneoencefálico severo recibido en la unidad de emergencia con una puntuación en la escala de Glasgow de 3 puntos; se describió en la tomografía computarizada un hematoma frontal epidural y una hemorragia subdural aguda; fue intervenido quirúrgicamente por neurocirugía en la Unidad de Emergencias y posteriormente fue llevado a la unidad de cuidados intensivos donde durante la recuperación (2 meses) refirió disminución de la agudeza visual en ojo izquierdo; fue evaluado en el servicio de Oftalmología donde la agudeza visual del ojo derecho fue de 20/40 y en ojo izquierdo no percibe la luz, en la evaluación oftalmológica se evidencia la presión intraocular en ojo izquierdo de 44mmHg, abundante celularidad en cámara anterior y a la evaluación ultrasonografía de cámara vítrea se describe una imagen que se correlaciona con una aparente hemorragia vítrea. Se diagnostica con Glaucoma de células fantasmas y síndrome de Terson; se inicia tratamiento médico con antiglaucomatoso para el glaucoma de células fantasmas y expectante para el síndrome de Terson, a la semana debido a la pobre respuesta se realizó trabeculectomia y vitrectomía vía Pars plana, posterior al tratamiento oftalmológico, se describió una visión de ojo izquierdo de 20/200.

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“…Given that patients most at risk of TS are least likely to communicate visual symptoms due to their neurological morbidity, the incidence of TS is probably higher than reported (14). Ophthalmological outcomes are usually favourable with conservative management, although some patients may require vitrectomy for non-clearing vitreous hemorrhage (15)(16)(17)(18). Neurological outcomes are worse in SAH if complicated by TS (19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

An explanation for Terson syndrome at last: the glymphatic reflux theory

et al. 2021

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Terson Syndrome (TS) describes the presence of intraocular hemorrhage in patients with intracranial hemorrhage, typically subarachnoid hemorrhage. Despite TS being a well-defined and frequently occurring phenomenon, its pathophysiology remains controversial. This review will present the current understanding of TS, with view to describing a contemporary and more plausible pathomechanism of TS, given recent advances in ophthalmic science and neurobiology. Previously proposed theories include a sudden rise in intracranial pressure (ICP) transmitted to the optic nerve sheath leading to rupture of retinal vessels; or intracranial blood extending to the orbit via the optic nerve sheath. The origin of blood in TS is uncertain, but retinal vessels appear to be an unlikely source. In addition, an anatomical pathway for blood to enter the eye from the intracranial space remains poorly defined. An ocular glymphatic system has recently been described, drainage of which from the globe into intracranial glymphatics is reliant on the pressure gradient between intraocular pressure and intracranial pressure. The glymphatic pathway is the only extravascular anatomical conduit between the subarachnoid space and the retina. We propose that subarachnoid blood in skull base cisterns near the optic nerve is the substrate of blood in TS. Raised ICP causes it to be refluxed through glymphatic channels into the globe, resulting in intraocular hemorrhage. We herewith present glymphatic reflux as an alternative theory to explain the phenomenon of Terson Syndrome. Response to Reviewers:Many thanks, please see the attached Word document which contains all responses to reviewer and editor comments in red. These are copied below as well.

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Clinical features and visual prognostic indicators after vitrectomy for Terson syndrome

Cited by 15 publications

References 28 publications

Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy

Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy

Glaucoma de células fantasmas secundario a Síndrome de Terson en un ojo fáquico

An explanation for Terson syndrome at last: the glymphatic reflux theory

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