Vitrectomy for long date bilateral Terson Syndrome

Author: Stefano Ciaccia (Italy)

Co-authors: Francesca Toto, Francesca Gorgoni, Paolo Milani, Filippo Nocera, Andrea Calciati, Fulvio Bergamini

Purpose

To describe the vitrectomy procedure and anatomical outcome of bilateral Terson syndrome in a young male.

Setting/Venue

The surgical procedure was performed in IRCCS Istituto Auxologico Italiano, Milan, Italy.

Methods

When presenting at our attention the 38 years-old patient had a best corrected visual acuity (BCVA) of light perception in both eyes (OO) with diffuse vitreous hemorrhage and no fundus visualization. Six months before he had a subarachnoid hemorrhage caused by a spontaneous rupture of an aneurism of left anterior cerebral artery. He has been hospitalized for two months in comatose condition and he recovered the ability of speaking only few weeks before our ophthalmological evaluation. Pars Plana Vitrectomy with 23 gauge device was performed in OO under retro bulbar anesthesia. Other than in the vitreous chamber, diffuse hemorrhage with hemosiderin accumulation was found between the posterior vitreous and the internal limiting membrane (ILM) and underneath the MLI. During the surgery, a macular hole (MH) was disclosed in the left eye and a complete peeling was performed, too.

Results

One week after the surgery, complete resolution of the vitreous hemorrhage was noted. Spectral-domain optical coherence tomography showed persistent MH in left eye and a diffuse retinal pigment epithelium (RPE) mottling in OO. Neuroretinal layers were preserved but complete atrophy of the foveal photoreceptors was noted. BCVA was counting fingers in the right eye and 20/400 in the left eye.

Conlusions

Terson syndrome combined with hemorrhage underneath the ILM is not rare, but the association with MH has been rarely reported. We can speculate that hemorrhages located under the retina or the ILM might elevate hydrodynamic pressure in the sub-retinal space and weaken the fovea causing the MH. Differently, the pre-macular hemorrhage might create tangential tractional forces over the fovea, leading to MH formation. Since blood has a toxic effect to the photoreceptors and RPE, due to oxidative stress, prompt surgery may be essential to avoid secondary damage on retinal layers.

Financial Disclosure

No financialrelations to disclose