Video Presentation

Macular haemorrhage during posterior vitrectomy in Terson syndrome

Video Details

First Author: J.García Sánchez SPAIN

Co Author(s):    M. C. Serra Verdu   J. R. Hueso Abancens   S. Nunez Marquez                       

Abstract Details



Purpose:

To present a clinical case of macular hemorrhage during pars plana victrectomy (PPV), in a case of bilateral Terson syndrome in young male.

Setting:

Hospital Universitario San Juan de Alicante, Alicante, Spain

Methods:

We present the case of a bilateral Terson Syndrome in a 40 years-old male, with history of cocaine abuse. He suffered from a secondary subarachnoid hemorrhage due to a ruptured Anterior Cerebral Artery aneurysm after which he spent 11 days in a coma. After recovery a visual acuity of fingers count in the right eye and hand movement in the left eye was detected. Funduscopy exam showed bilateral vitrous hemorrhage. No retinal detachment was seen by ultrasound. Therefore, Terson Syndrome was diagnosed.

Results:

After an initial period of observation of 2 months without spontaneous resolution of the hemorrhage, we decided a surgical approach. An uneventful PPV was performed in the left eye. Same manegement was planned for the right eye. During the second surgery we observed a macular hemorrhage. Initially we didn´t know the level of the hemorrhage (sub-hyaloids, sub-ILM or intra-retinal). After careful observation, it appeared to be located under the internal limiting membrane (ILM). To facilitate the evacuation of the macular membrane, we proceeded to perform a ILM peeling. One month posoperatively our patient had a VA of 20/20

Conclusions:

Terson's syndrome refers to the concurrence of vitreous hemorrhage with subarachnoid hemorrhage, usually due to a ruptured cerebral aneurysm. The intraocular hemorrhage is often unilateral and superficial to the retina. Intraretinal hemorrhages have been reported but are less frequent. The development of macular hemorrhage occurs in 40% of cases. It may be located under internal limiting membrane (sub-MLI) or between MLI and posterior hyaloids (preretinal). In our video, we show the surgery about a young male with bilateral Terson syndrome and development of macular hemorrhage in right eye, who recover a VA of 20/20 in both eyes after early vitrectomy.

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