TERSON-SYNDROME - RESULTS OF VITRECTOMY AND THE SIGNIFICANCE OF VITREOUS HEMORRHAGE IN PATIENTS WITH SUBARACHNOID HEMORRHAGE

Objective: The purpose of study A was to assess the effectiveness of v itrectomy for Terson syndrome. The purpose of study B was to determine the incidence and significance of vitreous hemorrhage in patients wit h subarachnoid hemorrhage. Design: Study A is a retrospective review o f case series. Study B is a prospective study. Participants: Study A e xamined a consecutive series of 4 children (7 eyes) and 23 adults (26 eyes). Study B examined a consecutive series of 100 patients. Interven tion: Subjects in study A underwent pars plana vitrectomy for dense vi treous hemorrhage following intracranial hemorrhage. In study B, ophth almoscopic examination of patients undergoing neurosurgery for rupture d cerebral aneurysms was used. Main Outcome Measures: In study A, the extent and rapidity of visual recovery and intraoperative and postoper ative complications were examined. In study B, the incidences of intra ocular hemorrhage and Terson syndrome in the cohort and the significan ce of the presence of vitreous hemorrhage in patients with subarachnoi d hemorrhage were examined. Results: Study A: There was substantial an d rapid visual improvement in 25 of the 26 eyes (96%) of the adult pat ients, with 21 eyes (81%) achieving greater than or equal to 20/30 fin al visual acuity. Only limited improvement was achieved in children's eyes (less than or equal to 20/60). Study B: Intraocular hemorrhage wa s found in 17% of eyes in patients with subarachnoid hemorrhage; the i ncidence of Terson syndrome was 8%. All patients with Terson syndrome and 89% of the patients with other types of intraocular hemorrhage had a history of coma compared with 46% of those without intraocular hemo rrhage (P = 0.0003). Conclusions: Vitreous hemorrhage in patients surv iving subarachnoid hemorrhage appears to be more common than previousl y thought, underscoring the need for routine funduscopic screening. Su rgical intervention is highly effective in hastening visual rehabilita tion of adults with Terson syndrome. The less encouraging results in i nfants may be due to amblyopia or direct brain damage caused by the ce rebrovascular incident.