Vitrektomie bei Terson-Syndrom - Bericht über 18 Fälle

Abstract

A vitrectomy was performed in 18 eyes (15 patients) with vitreous hemorrhages due to Terson's syndrome. The average age of the patients was 46.5 +/- 14.4 years. The mean interval between the acute event of an intracranial hemorrhage and the vitrectomy was 6.8 +/- 4.9 months. The vitreous hemorrhage was associated with epiretinal membranes in 3, PVR in 2, and retinal breaks and/or rhegmatogenous retinal detachment in 3 eyes. The vitrectomy had to be combined with membrane peeling in 2, encircling procedures or exoplants in 4, cryotherapy in 5, endolaser in 1, and air/SF6 gas filling in 3 eyes. A missing or incomplete posterior vitreous detachment in 8 eyes was associated with a higher risk of PVR and retinal detachment. Two eyes with this condition needed 3 secondary operations. The mean follow-up duration was 32 (1 to 126) months. Two patients died 4 and 11 months after the operation. The visual acuity improved significantly following vitrectomy in all 18 eyes. The final visual acuity was better than 20/40 in 73% and 20/25 to 20/20 in 56%. The initial postoperative visual acuity decreased later on due to nuclear cataract in 7 of 10 eyes of patients over 45 years of age. A complicated cataract developed in only 1 of 8 eyes of younger patients who maintained a mean visual acuity of 20/25. Vitrectomy for Terson's syndrome is recommended in bilateral cases without spontaneous clearing of the vitreous within 3 months, as well as in cases with PVR and imminent retinal detachment.(ABSTRACT TRUNCATED AT 250 WORDS)

Terson's syndrome in subarachnoid hemorrhage and severe brain injury accompanied by acutely raised intracranial pressure

“…7,13,25 In cases in which there is no tendency for blood resorption, the method of choice is a pars plana vitrectomy. 19 If vitrectomy is performed, complete recovery of vision can be expected in many cases. 19 If vitrectomy is performed, complete recovery of vision can be expected in many cases.…”

“…18 Most authors recommend a period of 6 months after the acute event for the timing of surgery. 6,19,26,31,37 Alternatively, intravitreous injections of anti-Rh serum have been reported to improve visual acuity within 5 to 6 weeks in cases of vitreous hemorrhage without proliferative vitreoretinopathy. 6,19,26,31,37 Alternatively, intravitreous injections of anti-Rh serum have been reported to improve visual acuity within 5 to 6 weeks in cases of vitreous hemorrhage without proliferative vitreoretinopathy.…”

“…6,19,26,31,37 Alternatively, intravitreous injections of anti-Rh serum have been reported to improve visual acuity within 5 to 6 weeks in cases of vitreous hemorrhage without proliferative vitreoretinopathy. 19,26 With regard to our own observations, multiple intracranial pathological conditions accompanied by acutely raised ICP may result in intraocular hemorrhage. These include the development of intraocular hypertension and retinal membrane formation with resulting retinal detachment.…”

Terson-Syndrom - Beitrag zum Operationszeitpunkt der Pars-plana-Vitrektomie

“…Roux [13] fand bei 10,5 % der Patienten mit einer Subarachnoidalblutung intraokulare Blutungen, während Gnanaraj [6] hierfür 3 -27 % und Shaw [16] 16 -40 % angaben. Pathophysiologisch liegt dem Terson-Syndrom eine abrupte orbitale und uveale Venostase zugrunde, die auf eine akute Hirndrucksteigerung infolge subarachnoidaler oder subduraler Blutungen zurückzuführen ist [8]. Früher nahm man an, dass das Blut über den Subarachnoidalraum der Sehnervenscheiden direkt in das Auge gelangt.…”

“…In Fällen lang anhaltender intravitrealer Blutungen führte die Separation des hinteren Glaskçrpers zur Bildung von "dome-shaped membranes" unterschiedlicher Grçße am hinteren Pol [20]. Meier [9] beschrieb postoperativ nach Vitrektomie Netzhautfalten, die durch eine deutlich sichtbare kreisrunde helle Linie begrenzt wurden im Sinne der von Kçrner [8] beschriebenen Fibroselinie. Kçrner…”