• Written By: Michael Vaphiades, DO
    Neuro-Ophthalmology/Orbit

    This interdisciplinary study analyzed the need for surgical intervention in Terson’s syndrome. It shows that vitrectomy, and internal limiting membrane peeling if needed, improved visual rehabilitation in patients with nonclearing vitreous hemorrhage after Terson’s syndrome.

    With one of the highest numbers of recruited patients and a model of a close, interdisciplinary collaboration of ophthalmologists and neurosurgeons, this prospective, uncontrolled study contributes to the management of this complex condition.

    Subjects included 102 patients with subarachnoid hemorrhage seen at a one hospital over a 24-month period. Mean patient age was 52.1±11.8 years. Patients presenting with an initial Glasgow Coma Scale (GCS) score and Hunt and Hess grade of less than 8 or with high Hunt and Hess grades were more affected by Terson’s. 

    The rate of Terson’s syndrome among subarachnoid hemorrhage patients was 19.6%, but the rate of vitreomacular hole (40%) was high, which the authors say may be related to improved patient survival rates and a sign of improved interdisciplinary treatment regimens.

    Of the 20 patients with Terson’s syndrome, eight (40%) underwent PPV for nonclearing vitreous bleeding. In four of these patients, ILM peeling was considered necessary because of sub-ILM bleeding. The mean interval between subarachnoid hemorrhage and PPV was 4.4 months.

    At a follow up of 6.4 months after PPV, visual acuity improved in all patients. BCVA at first and at last presentations were 2.2 and 0.0625 logMAR, respectively. For patients who underwent ILM peeling, these values were 1.725 and 0.05 logMAR, respectively.

    While there is no consensus among vitreoretinal surgeons as to the optimal timing of surgical intervention, the authors note that this case series of dense, nonclearing hemorrhage that persists for more than three months, they did not identify any safety concerns after PPV.