Terson's Syndrome-Rate and Surgical Approach in Patients with Subarachnoid Hemorrhage: A Prospective Interdisciplinary Study

OBJECTIVES: To analyze the need for surgical intervention in Terson's syndrome (TS) and the rate of TS, as well as the effect of pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling, complications, correlations between TS and sex, and the influence of the severity of subarachnoid hemorrhage (SAH) expressed by Glasgow Coma Scale (GCS) score and Hunt and Hess grade on the occurrence of TS.

DESIGN: Prospective, uncontrolled, interdisciplinary study.

PARTICIPANTS: A total of 102 patients with SAH over a period of 24 months.

METHODS: Patients were examined on days 1 and 14. A PPV was indicated in cases of nonresorbing vitreous hemorrhage (VH). Peeling of the ILM was performed with the help of ILM-BLUE (DORC, Zuidland, The Netherlands) using end-gripping ILM forceps.

MAIN OUTCOME MEASURES: Effect of PPV on visual acuity (VA) and timing of intervention in cases of nonresorbing VH.

RESULTS: The rate of TS was 19.6% (20/102). The mean age of the patients was 52.1±11.8 years. Patients presenting with an initial GCS of less than 8 or with high Hunt and Hess grades were more affected by TS. Eight (9 eyes) of the 20 patients with TS (40% of the patients with TS) underwent a PPV for nonclearing vitreous bleeding. In 4 patients (4 eyes; 20% of patients with TS), ILM peeling was considered necessary because of sub-ILM bleeding. The mean interval between SAH and PPV was 4.4 months (range, 3-5 months). Postoperative follow-up was 6.4 months. Visual acuity improved in all patients. Best-corrected VAs at first and at last presentations were 2.2 and 0.0625 logarithm of the minimum angle of resolution (logMAR), respectively. For patients who underwent ILM peeling, these values were 1.725 and 0.05 logMAR, respectively.

CONCLUSION: Pars plana vitrectomy and ILM peeling have beneficial effects on the visual rehabilitation of patients with nonclearing VH after TS. We did not identify any safety concerns after PPV in our patients with dense nonclearing hemorrhage that persisted for more than 3 months.