Outcome indicators for vitrectomy in Terson syndrome

Abstract

. Purpose: There is no general agreement on the best indication and timing of vitrectomy in patients suffering from Terson syndrome. Therefore, we reviewed our cases in order to assess factors interfering with the functional outcome and complication rates after vitrectomy. Methods: In this retrospective consecutive case series, the records from all patients undergoing vitrectomy for Terson syndrome between 1975 and 2005 were evaluated. Results: Thirty‐seven patients (45 eyes) were identified, 36 of whom (44 corresponding eyes) were eligible. The best‐corrected visual acuity (BCVA) at first and last presentation was 0.07 ± 0.12 and 0.72 ± 0.31, respectively. Thirty‐five eyes (79.5%) achieved a postoperative BCVA of ≥ 0.5; 26 (59.1%) eyes achieved a postoperative BCVA of ≥ 0.8. Patients operated on within 90 days of vitreous haemorrhage achieved a better final BCVA than those with a longer latency (BCVA of 0.87 ± 0.27 compared to 0.66 ± 0.31; P = 0.03). Patients younger than 45 years of age achieved a better final BCVA than older patients (0.85 ± 0.24 compared to 0.60 ± 0.33; P = 0.006). Retinal detachment developed in four patients between 6 and 27 months after surgery. Seven patients (16%) required epiretinal membrane peeling and seven cataract surgery. Conclusion: Ninety‐eight per cent of our patients experienced a rapid and persisting visual recovery after removal of a vitreous haemorrhage caused by Terson syndrome. A shorter time between occurrence of vitreous haemorrhage and surgery as well as a younger patient age are predictive of a better outcome. Generally, the surgical risk is low, but complications (namely retinal detachment) may occur late after surgery.

25G compared with 20G vitrectomy under Resight non-contact wide-angle lenses for Terson syndrome

“…The occurrence of retinal detachment with or without proliferative viteroretinopathy in Terson syndrome has been described previously (26). Retinal detachment is one of the more common postoperative complications reported in 9 and 32% of eyes in other studies where Terson syndrome was treated by vitrectomy (7,22). However, none of the eyes in this study exhibited retinal detachment and vitreous hemorrhage after vitrectomy, which may be due to the small number of cases.…”

“…Vitrectomy has been shown to be effective at improving BCVA in previous studies in the majority of patients (7). For example visual acuity of 20/40 or better has been achieved in 76-93% of patients (7,21,22). Variations in improving BCVA are apparently related to patient age and time elapsed between hemorrhage and surgery (7,23).…”

“…Slight inflammatory reaction occurred in all eyes in study group postoperatively, while several eyes in control group had inflammatory reaction a more severe, but this result comes from subjective feelings without objective indexes. Vitrectomy has been shown to be effective at improving BCVA in previous studies in the majority of patients (7). For example visual acuity of 20/40 or better has been achieved in 76-93% of patients (7,21,22).…”

“…For example visual acuity of 20/40 or better has been achieved in 76-93% of patients (7,21,22). Variations in improving BCVA are apparently related to patient age and time elapsed between hemorrhage and surgery (7,23). However, the majority of studies have used a 20G system.…”

“…Terson syndrome now encompasses any intraocular hemorrhage associated with intracranial hemorrhage and elevated intracranial pressures (2)(3)(4), which often results in significant morbidity and subsequent decreased quality of life. Vitrectomy has been proposed to have a role in treating Terson syndrome, and numerous studies have reported good visual recovery following surgery (5)(6)(7)(8). However, those studies were predominantly related to conventional 20G vitrectomy.…”