Outcomes of vitrectomy in terson syndrome: A multicenter Canadian perspective
What:
Paper Presentation | Présentation d'article
Part of:
When:
2:40 PM, Sunday 3 Jun 2018
(10 minutes)
Where:
How:
Authors: Samir Nazarali, Irfan Kherani, Bernard Hurley, Geoff Williams, Michael Fielden, Feisal
Adatia, Amin Kherani
Author Disclosure Block: S. Nazarali: None. I. Kherani: None. B. Hurley: None. G. Williams: None. M. Fielden: None. F. Adatia: None. A. Kherani: None.
Abstract Body:
Purpose: To characterize the presentation of Terson Syndrome (TS) and report on the outcomes of vitrectomy at two major ophthalmic centres in Canada. TS is defined as ocular hemorrhage resulting from intracranial hemorrhage. Literature investigating outcomes of vitrectomy in TS is limited and provides no consensus on the optimal time to perform surgery.
Study Design: Retrospective chart review.
Methods: All consecutive patients presenting with TS who subsequently underwent pars plana vitrectomy by retina specialists at the Calgary Retina Consultants, Southern Alberta Eye Centre and the University of Ottawa Eye Institute over the last 10 years. All patients underwent standard small guage pars plana vitrectomy. Additional procedures including membrane peel, endolaser, vitreous tamponade and cataract extraction were performed as necessary. The primary outcome of interest was the change in best-corrected visual acuity (BCVA) at three months from baseline. Secondary outcomes included the association between baseline BCVA and final BCVA and the association between BCVA and timing of surgery (early vs. later than 90 days).
Results: A total of 14 eyes of 11 patients met the inclusion criteria and underwent pars plana vitrectomy for TS. The mean time between intraocular hemorrhage and vitrectomy was 160 days, ranging from 29 to 859 days. Baseline preoperative BCVA was logMAR 1.57 ± 1.03. BCVA at the final postoperative follow-up was logMAR 0.53 ± 0.82, which was significantly improved compared to baseline (p=0.01). Further analysis demonstrated that baseline BCVA was not significantly correlated with final BCVA, Spearman’s rho= 0.016, p= 0.957. Additionally, BCVA did not significantly differ between those who had surgery prior to 90 days compared to after 90 days, p=0.087. The mean final BCVA among the six eyes undergoing vitrectomy prior to 90 days was 0.43 ± 0.78 compared to the eight eyes undergoing vitrectomy after 90 days, 0.61 ± 0.88. One eye required secondary surgery due to a retinal detachment and proliferative vitreoretinopathy.
Conclusions: Vitrectomy is safe, effective and should be considered for non-clearing vitreal bleeding due to TS. Our results would suggest that ocular hemorrhaging in TS can be observed conservatively for a period of time (for spontaneous improvement) without the risk of reduced visual potential. Ophthalmic evaluation should be considered promptly following intracranial hemorrhage especially for patients with concurrent vision loss. Following a period of observational management, vitrectomy surgery should be offered.
Author Disclosure Block: S. Nazarali: None. I. Kherani: None. B. Hurley: None. G. Williams: None. M. Fielden: None. F. Adatia: None. A. Kherani: None.
Abstract Body:
Purpose: To characterize the presentation of Terson Syndrome (TS) and report on the outcomes of vitrectomy at two major ophthalmic centres in Canada. TS is defined as ocular hemorrhage resulting from intracranial hemorrhage. Literature investigating outcomes of vitrectomy in TS is limited and provides no consensus on the optimal time to perform surgery.
Study Design: Retrospective chart review.
Methods: All consecutive patients presenting with TS who subsequently underwent pars plana vitrectomy by retina specialists at the Calgary Retina Consultants, Southern Alberta Eye Centre and the University of Ottawa Eye Institute over the last 10 years. All patients underwent standard small guage pars plana vitrectomy. Additional procedures including membrane peel, endolaser, vitreous tamponade and cataract extraction were performed as necessary. The primary outcome of interest was the change in best-corrected visual acuity (BCVA) at three months from baseline. Secondary outcomes included the association between baseline BCVA and final BCVA and the association between BCVA and timing of surgery (early vs. later than 90 days).
Results: A total of 14 eyes of 11 patients met the inclusion criteria and underwent pars plana vitrectomy for TS. The mean time between intraocular hemorrhage and vitrectomy was 160 days, ranging from 29 to 859 days. Baseline preoperative BCVA was logMAR 1.57 ± 1.03. BCVA at the final postoperative follow-up was logMAR 0.53 ± 0.82, which was significantly improved compared to baseline (p=0.01). Further analysis demonstrated that baseline BCVA was not significantly correlated with final BCVA, Spearman’s rho= 0.016, p= 0.957. Additionally, BCVA did not significantly differ between those who had surgery prior to 90 days compared to after 90 days, p=0.087. The mean final BCVA among the six eyes undergoing vitrectomy prior to 90 days was 0.43 ± 0.78 compared to the eight eyes undergoing vitrectomy after 90 days, 0.61 ± 0.88. One eye required secondary surgery due to a retinal detachment and proliferative vitreoretinopathy.
Conclusions: Vitrectomy is safe, effective and should be considered for non-clearing vitreal bleeding due to TS. Our results would suggest that ocular hemorrhaging in TS can be observed conservatively for a period of time (for spontaneous improvement) without the risk of reduced visual potential. Ophthalmic evaluation should be considered promptly following intracranial hemorrhage especially for patients with concurrent vision loss. Following a period of observational management, vitrectomy surgery should be offered.
