First Author: A.Gomez Moreno SPAIN
Co Author(s): E. Diaz de Durana Santa Coloma A. Larrauri Arana G. Garay Aramburu
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Terson syndrome is defined as a subarachnoid hemorrhage in association with intraocular hemorrhage, usually secondary to rupture of a cerebral aneurysm. Intraocular hemorrhage occurs in 20% of these patients and vitreous hemorrhage only afects 4%. The pathophysiology remains unknown. Some theories suggest that the blood reaches directly the vitreous cavity, through the optic nerve. Other authors suggest that an increase in intracraneal pressure causes elevation of the intraocular venous pressure, breaking the capillaries and leading to a vitreous hemorrhage. Intravitreal, subhyaloid, subinternal limiting membrane (ILM) and subretinal blood locations have been described.
Four patients developed a subarachnoid hemorrhage with intraocular hemorrhage associated. Two of them were bilateral.
One patient presented with a visual acuity of light perception (LP) in both eyes; the other three, presented counting fingers. Fundus examination revealed dense vitreous hemorrhage in all patients and subinternal limiting membrane hemorrhage in three patients. All four patients underwent pars plana vitrectomy (20g, 23g, 25g and 23g respectively), removal of the vitreous hemorrhage, internal limiting membrane peeling and blood aspiration.
The spontaneous resolution time of the hemorrhage varies from weeks to months, sometimes years, depending on the density of the hemorrhage. Our patients had dense vitreous hemorrhages and poor visual acuity (VA). Two of them had bilateral vitreous hemorrhage. After the vitrectomy the visual acuity improved in all patients. Complications such as retinal detachment, hypotony or vitreous hemorraghe were no reported. One patient developed cataract.
Terson Syndrome is a condition where a vitreous hemorrhage associate with subarachnoid hemorrhage due to trauma, systemic hypertension or ruptured aneurysm. The diagnosis may be delayed due to the impaired cognitive ability. The presence of Terson Syndrome is indicative of the severity of the subarachnoid hemorrhage. Our patients experienced a rapid and persisting visual recovery after the vitrectomy, also improve the ability to perform daily activities. The surgical risk is low, but the complications may occur some time later after vitrectomy.