Dissociated optic nerve fiber layer in a case of Terson syndrome

Tripathy, Koushik

doi:10.1177/1120672119853465

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…The DONFL is commonly observed after vitrectomy with ILM peeling and thought to be caused by ILM peeling. However, the DONFL can be observed even when the ILM is defective due to a disease in which ILM peeling is not performed [ 17 , 18 ]. Therefore, as in those cases, the DONFL can be observed even if the ILM is defective due to an ERM.…”

Section: Discussionmentioning

confidence: 99%

Dissociated optic nerve fiber layer-like appearance indicating an internal limiting membrane defect associated with an epiretinal membrane: two case reports

et al. 2022

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Background We report for the first time a way to predict the 2-dimensional extension of an internal limiting membrane (ILM) defect by detecting the area with dissociated optic nerve fiber layer (DONFL)-like spots in the preoperative optical coherence tomography (OCT) en-face images. Case presentations Case 1 was a 67-year-old man with metamorphopsia and decreased vision in his right eye. His best-corrected visual acuity (BCVA) was 20/100, with a pterygium, a moderate nuclear cataract, and an epiretinal membrane (ERM). Case 2 was a 73-year-old man with metamorphopsia and decreased vision in his left eye. His BCVA was 20/25, with a moderate nuclear cataract and an ERM. Both patients underwent simultaneous cataract surgery and pars plana vitrectomy with ERM and ILM peeling. Brilliant Blue G staining, performed before ERM and ILM peeling, revealed an unstained area. A careful evaluation of the area showed that it was not covered by either the ERM or ILM. A postoperative evaluation of the preoperative OCT images obtained from these cases showed DONFL-like low-brightness spots in the ILM defect area on the OCT en-face images. Conclusions OCT en-face images may indicate the area of the ILM defect. To avoid iatrogenic damage to the retinal nerve fiber layer by touching/pinching it with forceps, detecting areas with DONFL-like spots in the preoperative OCT en-face images may be useful to predict an ILM defect.

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Section: Discussionmentioning

confidence: 99%

Dissociated optic nerve fiber layer-like appearance indicating an internal limiting membrane defect associated with an epiretinal membrane: two case reports

et al. 2022

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“…Another important cause of VH is Terson’s syndrome, characterized by intra-ocular hemorrhages (retinal, sub-hyaloid, and vitreous) in patients with intra-cranial hemorrhage secondary to head trauma or rupture of aneurysm. [ 22 23 24 ] The pathogenesis of VH in these patients appears to be because of increased intra-cranial pressure forcing blood into the sub-arachnoid space and along the optic nerve sheath into the pre-retinal space or an acute rise in intra-ocular pressure (IOP) causing venous stasis and VH. Alternatively, a raised optic nerve sheath pressure secondary to the increased intra-cranial pressure results in compression and raised hydrostatic pressure in the central retinal vein, leading to VH.…”

Section: Pathomechanism Of Vitreous Hemorrhagementioning

confidence: 99%

Vitreous hemorrhage – Causes, diagnosis, and management

Shaikh

Srishti

Khanum

et al. 2022

Indian Journal of Ophthalmology

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Vitreous hemorrhage is associated with a myriad of conditions such as proliferative diabetic retinopathy, proliferative retinopathy following vascular occlusion and vasculitis, trauma, retinal breaks, and posterior vitreous detachment without retinal break. Multiple pathological mechanisms are associated with development of vitreous hemorrhage such as disruption of abnormal vessels, normal vessels, and extension of blood from an adjacent source. The diagnosis of vitreous hemorrhage requires a thorough history taking and clinical examination including investigations such as ultra-sonography, which help decide the appropriate time for intervention. The prognosis of vitreous hemorrhage depends on the underlying cause. Treatment options include observation, laser photo-coagulation, cryotherapy, intravitreal injections of anti-vascular endothelial growth factor, and surgery. Pars plana vitrectomy remains the cornerstone of management. Complications of vitreous hemorrhage include glaucoma (ghost cell glaucoma, hemosiderotic glaucoma), proliferative vitreoretinopathy, and hemosiderosis bulbi.

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“…Differential diagnoses include traumatic retinopathy, posterior vitreous detachment, diabetic retinopathy, hypertensive retinopathy, sickle cell retinopathy, Purtscher's retinopathy, Terson's syndrome [23], ruptured macroaneurysm, intraocular parasites, and retinal detachment [24]. Therefore, it is important to interpret clinical examination findings in the context of a thorough patient history.…”

Section: Differential Diagnosismentioning

confidence: 99%

A brief review of Valsalva retinopathy

Asteris¹,

Kalogeropoulos²,

Moussa³

et al. 2022

Med Hypothesis Discov Innov Optom

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Background: Valsalva retinopathy is a specific type of retinopathy that appears following an acute rise in intrathoracic or intra-abdominal pressure. This review focuses on current literature and future directions for the diagnosis and management of Valsalva retinopathy. Methods: In this brief review, the literature was searched to provide an extensive general and updated description of Valsalva retinopathy, focusing on its management and prognosis. Selected articles are summarized to present the etiology, general pathology, pathophysiology, symptoms, signs, diagnosis, differential diagnosis, treatment, and prognosis of Valsalva retinopathy. Results: The main symptom of Valsalva retinopathy is loss of visual acuity following exertion. This is caused by the rupture of small superficial vessels in the macula and perimacular areas, leading to extravasation of blood. No link between age, sex, or race has been found, although fundus vessel abnormalities pose some predisposition to the disease. During fundoscopy, Valsalva retinopathy appears most frequently as well-defined preretinal hemorrhages confined to the sub-internal limiting membrane (ILM) or subhyaloid space. If ILM rupture occurs, hyaloid hemorrhage can appear. Diagnosis is based on the patient’s medical history and a standard examination. Usually, only observation of the patient is required, with the hemorrhage resolving within weeks to months. In cases of large premacular hemorrhage or large sub-ILM/subhyaloid hemorrhage, vitrectomy or Nd:YAG krypton laser membranotomy can be performed. Conclusions: Of all the aspects of Valsalva retinopathy that might trouble the physician, the most challenging features are differential diagnosis and the choice of optimal treatment. Therapeutic strategies for Valsalva retinopathy can be either conservative or based on Nd:YAG laser membranotomy and/or vitrectomy. All methods seem to have good outcomes. However, physicians should not be afraid of advancing beyond conservative therapy, especially in the event of persistent premacular hemorrhage, which could lead to permanent retinal damage if valuable time is lost, even after vitrectomy.

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Dissociated optic nerve fiber layer in a case of Terson syndrome

Cited by 5 publications

References 9 publications

Dissociated optic nerve fiber layer-like appearance indicating an internal limiting membrane defect associated with an epiretinal membrane: two case reports

Dissociated optic nerve fiber layer-like appearance indicating an internal limiting membrane defect associated with an epiretinal membrane: two case reports

Vitreous hemorrhage – Causes, diagnosis, and management

A brief review of Valsalva retinopathy

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