Vitreous Hemorrhage after Aneurismal Rupture: Terson Syndrome

Introduction Terson syndrome is described as an intraocular hemorrhage consequent to a spontaneous subarachnoid hemorrhage (SSAH). In the present article, we describe cases of patients who underwent neurosurgical treatment of ruptured cerebral aneurysm at our institution over a period of one year, and who were diagnosed with Terson syndrome. Methods The present study included patients with a diagnosis of SSAH by rupture of a cerebral aneurysm who underwent treatment in our neurosurgical service from December 2009 to December 2010. The patients were followed-up for a minimum of 20 months. We have also performed a literature review and compared the data with those available in the current literature. Results The present study included 34 patients, 18 (53%) of which underwent endovascular treatment, and 16 (47%) who underwent microsurgical clipping. In the sample, the mortality was 14.7% (5 patients), the same percentage of patients who were diagnosed with Terson Syndrome, which is an incidence of 14.7%. Regarding the ophthalmologic evaluation, all patients had vitreous hemorrhage detected by an ultrasound examination, which was unilateral in only two patients. Visual acuity improved in all patients, being incomplete in only one of them. Conclusion Terson syndrome is relatively common and is associated with higher mortality. With the existence of an effective treatment, it should be investigated in all patients with SSAH.

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Surgical outcomes of minimally invasive vitrectomy surgery in Eales’ disease

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v5i2.8710 ◽

2013 ◽

Vol 5 (2) ◽

pp. 182-189

Author(s):

S Khanduja ◽

S Gupta ◽

S Sinha ◽

Pradeep Venkatesh ◽

R Vohra ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Surgical Outcomes ◽

Case Series ◽

Vitreous Hemorrhage ◽

Neovascular Glaucoma ◽

Retinal Breaks ◽

Eales Disease ◽

23 Gauge ◽

One Year

Introduction: The results of surgical outcomes of 20 gauge pars plana vitrectomy in Eales’ disease are available in the scientific literature. However, all these studies have been done using the 20 gauge vitrectomy systems and most studies have been conducted in a retrospective manner. Objective: To evaluate the outcomes and safety of 23 gauge vitrectomy in complications of Eales’ disease. Materials and methods: Study design: Consecutive interventional case series. Participants: Seventy-six eyes of 72 nonconsecutive patients undergoing 23-gauge vitrectomy for complications of Eales’ disease were enrolled. The participants were followed up for a minimum of one year. Intervention: The participants underwent a complete demographic, medical and ophthalmic evaluation. A 23-gauge vitrectomy was performed. Endotamponade was used when necessary. Perioperative and postoperative events were recorded. Primary outcome measures were visual acuity and complications arising due to surgery. Results: Indication for surgery was non-clearing vitreous hemorrhage in 89.4% (68/76) and secondary retinal detachment in 10.6% (8). Visual acuity improved from Log Mar 1.80 ± 0.19 units preoperatively to Log Mar 0.47±0.59. Best-corrected visual acuity equivalent to Snellen 6/9 was achieved in 77. 6% of eyes. . Surgical failure was seen in 6.5% cases. Four cases were lost due to progression to neovascular glaucoma and 1 case was lost to severe residual retinal detachment. Iatrogenic portside retinal breaks occurred in 3.9% (3), post-vitrectomy retinal detachment 2.6% ( 2), hypotony 1.3% (1) and cataract in 38.1% (28) cases. Conclusion: 23-gauge sutureless vitrectomy in patients with Eales’ disease is a safe and effective technique with acceptable level of risk and complications. Nepal J Ophthalmol 2013; 5(10): 182-189 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8710

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Intraocular Silicone Oil Masquerading as Terson Syndrome

Case Reports in Ophthalmological Medicine ◽

10.1155/2016/4942109 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3

Author(s):

Navid Elmi Sadr ◽

Bijan Samavat ◽

Payam Mehrian ◽

Alireza Hedayatfar

Keyword(s):

Computed Tomography ◽

Intracranial Hemorrhage ◽

False Positive ◽

Silicone Oil ◽

Vitreous Hemorrhage ◽

Diabetic Woman ◽

High Attenuation ◽

Terson Syndrome ◽

Intraocular Hemorrhage ◽

Positive Results

Introduction. Terson syndrome is described as intraocular hemorrhage in association with any type of intracranial hemorrhage and is associated with higher mortality rate and vision loss. Intraocular hemorrhage in Terson syndrome may be diagnosed using computed tomography but there are false positive results. Silicone oil which is widely used for internal tamponade of complicated retinal detachments has high attenuation on computed tomography and hyperintensity on T1-weighted magnetic resonance imaging that can mimic intraocular hemorrhage. This report shows that silicone oil is another origin of false positive results in interpreting CT findings for detecting Terson syndrome.Case Report. A 71-year-old diabetic woman presented with loss of consciousness. Brain computed tomography revealed right cerebellar hemorrhage and ventricular hemorrhage and hyperdensity in vitreous cavity of the left eye that was initially interpreted as vitreous hemorrhage. Terson syndrome was the initial diagnosis but ophthalmoscopic examination and brain MRI showed that the left eye had silicone oil tamponade.Conclusion. Without knowing the history of previous vitreoretinal surgery, CT scan findings of intraocular silicone oil may be interpreted as vitreous hemorrhage. In patients with concomitant intracranial hemorrhage, it can masquerade as Terson syndrome.

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Computed Tomography Angiography (CTA) Evaluation of Spontaneous Subarachnoid Hemorrhage

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v6i2.50745 ◽

2020 ◽

Vol 6 (2) ◽

pp. 78-81

Author(s):

Md Tauhidul Islam Chowdhury ◽

Mohammad Shah Jahirul Hoque Chowdhury ◽

Mohammad Sadekur Rahman Sarkar ◽

KM Ahasan Ahmed ◽

Md Nazmul Kabir ◽

...

Keyword(s):

Computed Tomography ◽

Subarachnoid Hemorrhage ◽

Computed Tomography Angiography ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Multiple Aneurysm ◽

Traumatic Subarachnoid Hemorrhage ◽

One Year ◽

Spontaneous Subarachnoid Hemorrhage

Background: In evaluation of non-traumatic subarachnoid hemorrhage CT angiography (CTA) has 97-98% sensitivity and near 100% specificity. Objective: This study was conducted to evaluate the CTA findings of CT positive non traumatic subarachnoid hemorrhage. Methodology: This is an observational cross sectional study performed in Neurology department of National Institute of Neurosciences and Hospital, Dhaka over one year period (January 2019 to December 2019). Total 87 CT positive subarachnoid hemorrhage cases were purposively included in this study. All CT positive patients underwent CTA of Cerebral vessels for further evaluation. The angiography were evaluated by competent neuro-radiologists blinded about the study. Result: Among 87 patients, 40.2% were male and 59.8% were female. The average age was 53.33±11.1 years. Among the studied patient the source of bleeding was found 78.16% aneurysmal and 21.84% non-aneurysmal. 85.30% patients had single aneurysm and 14.70% had multiple aneurysm. The highest number of patient had Acom aneurysm (41.17%) followed by MCA (22.05%), ICA (13.23%), ACA (7.35%) and vertebral artery (1.14%) in order of frequency. Among the multiple aneurysm group most of the patients had combination of Acom, MCA and ICA aneurysm. Conclusion: From this study, we can conclude that CTA can be used as the primary diagnostic tool in evaluation of spontaneous SAH. Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 78-81

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Predictors for 2-year functional and morphological outcomes of a treat and extend regimen with ranibizumab in patients with diabetic macular edema

Ophthalmic Research ◽

10.1159/000514721 ◽

2021 ◽

Author(s):

Helena Giannakaki-Zimmermann ◽

Alexandra Behrndt ◽

Laura Hoffmann ◽

Maria-Magdalena Guichard ◽

Cengiz Tuerksever ◽

...

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Loading Dose ◽

Treatment Frequency ◽

Treat And Extend ◽

Free Treatment ◽

Younger Age ◽

One Year ◽

Treat And Extend Regimen

Abstract Purpose: To investigate longer-term functional and morphological outcomes and their predictors in diabetic macular edema (DME) following a treat and extend regimen (TER) without loading dose under ranibizumab. Methods: Patient data were reviewed and analyzed retrospectively over a period of 24 months after initiation of TER. Best-corrected visual acuity (BCVA), treatment frequency as well as quantitative and qualitative Spectral-domain Optical Coherence Tomography parameters were assessed. Results: 118 eyes of 87 patients were included. A mean of 9.742.13 injections in the first and 7.632.29 in the second year were applied. There were significant gains of BCVA and reductions in central retinal thickness from baseline to month 12 and 24 (all p<0.001). Percentage of eyes with an intact inner-/outer segment (IS/OS) junction increased from 15.3% at baseline to 42.1% at month 24 (p<0.001). An intact IS/OS junction at baseline increased the probability of having a dry retina after 12 months by 79.3% (p=0.017) and after 24 months by 88.1% (p=0.040). Less IS/OS disruption at baseline predicted longer maximum recurrence-free treatment intervals at 2 years (r=-0.345, p<0.001) and better BCVA at one year (r=-0.347, p<0.001). Baseline bigger intraretinal cysts were associated with more IS/OS disruption at 24 months (r=0.305, p=0.007). Younger age and lower BCVA at baseline were predictive for a higher BCVA gain at 24 months (p=0.046, p<0.001). Conclusion: Ranibizumab applied in a TER without loading dose in DME significantly improves visual acuity and retinal anatomical structure throughout two years. The evaluated predictors might help to guide routine clinical treatment in DME.

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27-gauge trocar-assisted sutureless intraocular lens fixation

BMC Ophthalmology ◽

10.1186/s12886-020-01758-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tatsuya Jujo ◽

Jiro Kogo ◽

Hiroki Sasaki ◽

Reio Sekine ◽

Keiji Sato ◽

...

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Cell Density ◽

Intraocular Lens ◽

Vitreous Hemorrhage ◽

Corneal Endothelial Cell ◽

Endothelial Cell Density ◽

Corneal Endothelial Cell Density ◽

The Mean ◽

Iol Fixation

Abstract Backgrounds However there have been numerous investigations of intrascleral intraocular lens (IOL) fixation techniques, there is room for improvement in terms of simplifying complicated techniques and reducing the high levels of skill required. This study aimed to report a novel technique for sutureless intrascleral fixation of the IOL using retinal forceps with a 27-gauge trocar. Methods Nineteen eyes of 18 patients underwent intrascleral fixation of the IOL from July 2018 to September 2019 were enrolled in this study. A 27-gauge trocar formed 3-mm scleral tunnels positioned at 4 and 10 o’clock, 2 mm from the corneal limbus. We used a 3-piece IOL haptic grasped by a 27-gauge retinal forceps and pulled from the 27-gauge trocar. The IOL was fixed by making a flange. Main outcome measures were visual acuity, corneal endothelial cell density, IOL tilt, decentration, predicted error of refraction and complications. Results The 19 eyes were followed up for 1 month. The mean pre- and postoperative logMAR uncorrected visual acuity (UCVA) was 1.06 ± 0.63 and 0.40 ± 0.26, respectively (p < 0.01), while the mean pre- and postoperative logMAR best corrected visual acuity (BCVA) was 0.27 ± 0.51 and 0.06 ± 0.15, respectively (p = 0.09). The mean corneal endothelial cell density was 2406 ± 625 to 2004 ± 759 cells/mm2 at 1 month (p = 0.13). The mean IOL tilt was 3.52 ± 3.00°, and the mean IOL decentration was 0.39 ± 0.39 mm. There was no correlation among IOL tilt, decentration and BCVA (p > 0.05). The mean prediction error of the target refraction was − 0.03 ± 0.93 D. The complications were vitreous hemorrhage (3 eyes), hyphema (1 eye), IOP elevation (1 eye), iris capture of the IOL (1 eye) and hypotony (2 eyes). No IOL dislocation occurred. Conclusions IOL intrascleral fixation with a flange achieved good IOL fixation and visual outcome in the scleral tunnels created with the 27-gauge trocar.

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Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy

European Journal of Ophthalmology ◽

10.1177/11206721211000648 ◽

2021 ◽

pp. 112067212110006

Author(s):

Xin Liu ◽

Lufei Wang ◽

Fengjuan Yang ◽

Jia’nan Xie ◽

Jinsong Zhao ◽

...

Keyword(s):

Visual Acuity ◽

Surgical Management ◽

Pediatric Patients ◽

Vitreous Hemorrhage ◽

Visual Outcome ◽

Poor Visual Outcome ◽

Early Vitrectomy ◽

Open Globe ◽

Time From Injury ◽

Ocular Sign

Purpose: To describe surgical management and establish visual outcomes of open globe injury (OGI) in pediatric patients requiring vitrectomy. Methods: Forty-eight eyes of 48 pediatric patients underwent vitrectomy for OGI with secondary vitreoretinal complications in the eye center of Jilin University were included. Characteristics of patients, details of ocular examination and operation, presenting and final visual acuity were recorded. Results: Presenting visual acuity less than 20/400 was found in 44 eyes (91.7%), which included no light perception (NLP) in four eyes. At last visit, there was no eyes with visual acuity of NLP, and 19 eyes (39.6%) had a vision recovery to 20/400 or better. Mechanisms of injury, intraocular contents prolapse, presence of hyphema, intraocular foreign body, vitreous hemorrhage, retinal detachment, and total time from injury to PPV > 2 weeks were significant predictors of visual prognosis. Logistic regression analysis showed that hyphema was a significant predictive factor for poor visual outcome. Conclusion: Visual acuity was improved in most of the patients with OGI in this study. Hyphema is an important presenting ocular sign in estimating the post-vitrectomy visual outcome for OGI in children. Proper timing of vitrectomy is suggested, and in this study patients may benefit more with early vitrectomy as less proliferative vitreoretinopathy (PVR) was found together with a better visual acuity.

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Customised gold weight eyelid implantation in paralytic lagophthalmos

The Journal of Laryngology & Otology ◽

10.1017/s0022215108001886 ◽

2008 ◽

Vol 122 (10) ◽

pp. 1088-1091 ◽

Cited By ~ 7

Author(s):

N Jayashankar ◽

K P Morwani ◽

M J Shaan ◽

S R Bhatia ◽

K T Patil

Keyword(s):

Visual Acuity ◽

Prospective Study ◽

Study Design ◽

Study Group ◽

Upper Eyelid ◽

Eyelid Closure ◽

Gold Weight ◽

One Year ◽

A Prospective Study

AbstractGold eyelid implantation is widely considered the procedure of choice to reanimate the upper eyelid in paralytic lagophthalmos. Commercially supplied implants are not readily available in all places and are sometimes cumbersome to import.Objective:We aimed to devise a method whereby every surgeon performing gold eyelid implantation could have easy and quick access to the implant. Furthermore, we aimed to develop a means of creating an implant of the exact weight required for complete eyelid closure.Study design and setting:A prospective study was performed from 1997 to 2005 in a tertiary research hospital, involving 50 subjects requiring gold upper eyelid implantation and using the technique in question.Results:Only patients with a minimum follow up of one year were included in the study group. Symptoms improved in 96 per cent of subjects, who were able to dispense with eyedrops and eye ointments. Visual acuity improved in 92 per cent of patients. There were two extrusions amongst the early cases.Conclusion and significance:Customised gold eyelid implantation offers an alternative in regions where commercial implants are not easily obtained.

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Terson Syndrome: A Case of Intraocular Hemorrhage Secondary to Intracerebral Hemorrhage

Consultant ◽

10.25270/con.2021.11.00001 ◽

2021 ◽

Author(s):

Kenneth Lam ◽

◽

Nisarg Joshi ◽

Jonathan Tsui ◽

Benjamin Hale ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Terson Syndrome ◽

Intraocular Hemorrhage

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Retrograde Suction Decompression for Clipping of a Giant Ophthalmic Internal Carotid Artery Aneurysm: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab349 ◽

2021 ◽

Author(s):

Visish M Srinivasan ◽

Michael Zhang ◽

Lea Scherschinski ◽

Alexander C Whiting ◽

Mohamed A Labib ◽

...

Keyword(s):

Visual Acuity ◽

Carotid Artery ◽

Internal Carotid ◽

Artery Aneurysm ◽

Carotid Bifurcation ◽

Aneurysm Neck ◽

Microsurgical Clipping ◽

Complex Anatomy ◽

Internal Carotid Artery Aneurysm ◽

Paraclinoid Aneurysms

Abstract Microsurgical clipping of large paraclinoid aneurysms is challenging because of the complex anatomy of the dural rings, lack of easy proximal control, and wide aneurysm necks. Proximal retrograde suction decompression, or the Dallas technique, can reduce aneurysm turgor and, with aspiration of the trapped cervical and supraclinoid internal carotid arteries (ICAs), can collapse the aneurysm to aid microsurgical clipping.1-5 A woman in her late 30s presented with decreased right-eye visual acuity. Informed written consent was obtained for microsurgical management and publication. Upon cervical exposure of the carotid bifurcation, we performed a standard pterional craniotomy, trans-sylvian exposure, and intradural anterior clinoidectomy. After burst suppression and cross-clamping of the carotid, we inserted an angiocatheter at the common carotid artery (CCA). Distal temporary clips were placed on the posterior communicating artery and C7 ICA. With the cervical ICA unclamped, retrograde suction was continuously applied to deflate the aneurysm. We applied 2 pairs of fenestrated-booster clips to the aneurysm dome and a fifth clip to the aneurysm neck. After restoration of flow, indocyanine green angiography and Doppler assessments were performed. The proximal clip was converted into a curved clip to optimize ICA flow. Postoperative angiography confirmed complete occlusion of the aneurysm. The patient was discharged on postoperative day 3, with stable visual acuity.6 This video demonstrates that retrograde suction decompression via the cervical CCA can be safely performed to facilitate clipping of complex paraclinoid ICA aneurysms. Comprehensive planning of temporary aneurysm trapping for suction decompression and permanent clip construct for aneurysm occlusion are needed for effective aneurysm repair.

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