1Neurological Institute, and.
2Department of Ophthalmology, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
J Neurosurg. 2019 Feb 1;130(2):517-524. doi: 10.3171/2017.7.JNS171302. Epub 2018 Feb 2.
Approximately 10% of patients with subarachnoid hemorrhage (SAH) become permanently, legally blind. The average cost of lifetime support and unpaid taxes for each blind person amounts to approximately $900,000. This study evaluates the feasibility and potential role of bedside optical coherence tomography (OCT) in Terson’s syndrome (TS) in patients with acute SAH (aSAH) and its potential role in blindness prevention.
The authors conducted an open-label pilot study, in which 31 patients with an angiographic diagnosis of aSAH were first screened for TS with dilated funduscopy and then with OCT in the acute phase and at 6-week followup visits. Outpatient mood assessments (Patient Health Questionnaire–depression module, Hamilton Depression Scale), and quality of life general (NIH Patient-Reported Outcomes Measurement Information System) and visual scales (25-item National Eye Institute Visual Functioning Questionnaire) were measured at 1 and 6 weeks after discharge. Exclusion criteria included current or previous history of severe cataracts, severe diabetic retinopathy, severe macular degeneration, or glaucoma.
OCT identified 7 patients with TS, i.e., a 22.6% incidence in our aSAH sample: 7 in the acute phase, including a large retinal detachment that was initially missed by funduscopy and diagnosed by OCT in follow-up clinic. Dilated retinal funduscopy significantly failed to detect TS in 4 (57.1%) of these 7 cases. Intraventricular hemorrhage was significantly more common in TS cases (85.7% vs 25%). None of the participants experienced any complications from OCT examinations. Neither decreased quality of life visual scale scores nor a depressed mood correlated with objective OCT pathological findings at the 6-week follow-up after discharge. There were no significant mood differences between TS cases and controls.
OCT is the gold standard in retinal disease diagnosis. This pilot study shows that bedside OCT examination is feasible in aSAH. In this series, OCT was a safe procedure that enhanced TS detection by decreasing false-negative/inconclusive funduscopic examinations. It allows early diagnosis of macular holes and severe retinal detachments, which require acute surgical therapy to prevent legal blindness. In addition, OCT aids in ruling out potential false-positive visual deficits in individuals with a depressed mood at follow-up.
约 10%的蛛网膜下腔出血（SAH）患者会永久性失明。每个盲人的终生支持和未付税款的平均成本约为 90 万美元。本研究评估了床边光学相干断层扫描（OCT）在急性 SAH（aSAH）患者中 Terson 综合征（TS）的可行性和潜在作用，以及其在预防失明方面的潜在作用。
作者进行了一项开放标签的试点研究，共对 31 例血管造影诊断为 aSAH 的患者进行了 TS 筛查，先用眼底镜，然后在急性期和 6 周随访时用 OCT 进行筛查。出院后 1 周和 6 周分别进行门诊情绪评估（患者健康问卷-抑郁模块、汉密尔顿抑郁量表）和生活质量一般（NIH 患者报告的结果测量信息系统）和视觉量表（25 项国立眼科研究所视觉功能问卷）。排除标准包括当前或以前有严重白内障、严重糖尿病视网膜病变、严重黄斑变性或青光眼病史。
OCT 发现了 7 例 TS，即我们的 aSAH 样本中发病率为 22.6%：急性期 7 例，包括眼底镜最初漏诊的大视网膜脱离，OCT 在随访时发现。在这 7 例中，有 4 例（57.1%）眼底镜明显未能发现 TS。脑室出血在 TS 病例中更为常见（85.7%比 25%）。OCT 检查均无并发症。出院后 6 周随访时，视觉量表评分下降或情绪低落均与客观 OCT 病理发现无关。在出院后 6 周的随访中，TS 病例和对照组之间没有明显的情绪差异。
OCT 是视网膜疾病诊断的金标准。这项试点研究表明，床边 OCT 检查在 aSAH 中是可行的。在本系列中，OCT 是一种安全的检查方法，通过减少假阴性/不确定的眼底镜检查，提高了 TS 的检出率。它可以早期诊断黄斑裂孔和严重视网膜脱离，需要急性手术治疗以预防法律失明。此外，OCT 有助于排除在随访时有情绪低落的个体中潜在的假阳性视觉缺陷。
