Lima-Fontes Mario, Leuzinger-Dias Mariana, Rodrigues Rita, Barros-Pereira Ricardo, Falcão Manuel, Fernandes Vítor, Alves-Faria Pedro, Falcão-Reis Fernando, Rocha-Sousa Amândio
Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal.
Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4200-319, Portugal.
Clin Ophthalmol. 2023 Jan 25;17:351-359. doi: 10.2147/OPTH.S396781. eCollection 2023.
The purpose of this study was to characterize the clinical presentation, management strategy and visual outcomes of patients diagnosed with Terson syndrome and followed in a tertiary centre in Portugal.
A single-centre retrospective study was performed, based on the survey review of the medical records of every consecutive patient diagnosed with Terson syndrome and followed from January 2018 to August 2021. The change in best-corrected visual acuity (BCVA) from baseline to the final evaluation was the primary outcome.
Fifteen eyes from 8 patients (50% female) were included. The mean age at diagnosis was 55±7 years. The neurological event was traumatic brain injury in 37.5% (n=3) and subarachnoid haemorrhage in 62.5% of the patients (n=5). Bilateral intraocular haemorrhage occurred in 875% (n=7) of the patients. Vitreous and preretinal haemorrhages occurred each in 66.7% (n=10), intraretinal in 30% (n=3) and subretinal in 13.3% (n=2) of the eyes. In 40% of the eyes (n=6), spontaneous resolution of intraocular haemorrhage occurred, while PPV was performed in the remaining 60% (n=9). Ocular haemorrhage detection occurred 58.47 ± 40.94 days after the neurological event (range 11 to 121 days). Baseline BCVA was 1.11 ± 1.01 logMAR and improved to 0.32 ± 0.69 logMAR in the follow-up period (p=0.004). A positive correlation was found between initial and final BCVA (Spearman's rho = 0.643, p=0.01). Baseline BCVA of eyes undergoing PPV was lower than of those conservatively managed (1.84±0.72 vs 0.20±0.28 logMAR, p<0.001). However, there were no statistically significant differences in final BCVA after surgery or observation (0.56 ± 0.90 vs 0.04 ± 0.04 logMAR, p=0.149). Longer periods between the neurological and the ophthalmological diagnosis were correlated with worse final BCVA (Spearman's rho = 0.688, p=0.005).
Terson syndrome is a potential cause of irreversible visual loss. Diagnosis delay may affect visual prognosis. PPV is indicated when intraocular haemorrhage is dense and does not resolve spontaneously or when visual acuity at presentation is low, allowing for good visual outcomes with minimal complications.
本研究旨在描述在葡萄牙一家三级中心确诊并接受随访的泰尔森综合征患者的临床表现、管理策略和视力预后。
进行了一项单中心回顾性研究，基于对2018年1月至2021年8月期间每例连续确诊为泰尔森综合征并接受随访患者的病历进行调查回顾。从基线到最终评估时最佳矫正视力（BCVA）的变化是主要结局。
纳入了8例患者（50%为女性）的15只眼。诊断时的平均年龄为55±7岁。37.5%（n = 3）的患者神经事件为创伤性脑损伤，62.5%的患者（n = 5）为蛛网膜下腔出血。87.5%（n = 7）的患者发生双侧眼内出血。玻璃体和视网膜前出血各占66.7%（n = 10），视网膜内出血占30%（n = 3），视网膜下出血占13.3%（n = 2）。40%的眼（n = 6）眼内出血自发吸收，其余60%（n = 9）行玻璃体切割术（PPV）。眼内出血在神经事件后58.47±40.94天被发现（范围为11至121天）。基线BCVA为1.11±1.01 logMAR，随访期间改善至0.32±0.69 logMAR（p = 0.004）。初始和最终BCVA之间存在正相关（Spearman秩相关系数 = 0.643，p = 0.01）。接受PPV的眼的基线BCVA低于保守治疗的眼（1.84±0.72 vs 0.20±0.28 logMAR，p<0.001）。然而，手术或观察后的最终BCVA无统计学显著差异（0.56±0.90 vs 0.04±0.04 logMAR，p = 0.149）。神经诊断和眼科诊断之间的间隔时间越长，最终BCVA越差（Spearman秩相关系数 = 0.688，p = 0.005）。
泰尔森综合征是不可逆视力丧失的潜在原因。诊断延迟可能影响视力预后。当眼内出血浓密且不能自发吸收或就诊时视力低下时，建议行PPV，可获得良好的视力预后且并发症最少。
