17.9 Terson’s Syndrome

Fig. 17.55 Familial exudative vitreoretinopathy may present with vitreous haemorrhage or exudative retinal detachment

Fig. 17.56 A deep sclerotomy has been created as deep as possible in uveal effusion syndrome

Fig. 17.57 This patient was found to have a subretinal haemorrhage adjacent to the fovea after removal of vitreous haemorrhage from Terson’s syndrome. The vision remained at 20/120 despite retraction of the subretinal haemorrhage from the fovea

17.8.2 Surgery

Deep sclerectomy of large patches of sclera between the extraocular muscles is effective in reversing the exudation in most patients. Incise the sclera to 90 % depth, and excise as large a patch as possible in two quadrants. Decompression of the vortex veins in addition has been described but appears not to be necessary. Nanophthalmic eyes are less likely to respond to surgery.

17.9Terson’s Syndrome

Patients with subarachnoid haemorrhage from intracerebral aneurysms may develop intraocular bleeds (Terson 1900; van Rens et al. 1983; Weingeist et al. 1986; Schultz et al. 1991; Kuhn et al. 1998; Murjaneh et al. 2006; Garweg and Koerner 2009). Histopathology has shown haemorrhage in the vitreous, subhyloid, sub-ILM, intraretinal and in the optic nerve and the optic nerve sheath. Secondary complications such as macular hole have been seen (Rubowitz and Desai 2006). The hyaloid is often attached during surgery, sub-ILM blood can be evacuated, but the retina may suffer damage from the blood or from subretinal or intraretinal bleeds. A high rate of entry site breaks have been reported after PPV surgery (Murjaneh et al. 2006).

17.10 Disseminated Intravascular Coagulation

This severe presentation after septicaemia, involving widespread intravascular coagulation resulting in loss of clotting factors, is associated with multiorgan vascular occlusion and haemorrhage. In the eye, it has been associated with choroidal infarction and vitreous haemorrhage with retinal damage and proliferative vitreoretinopathy (Lewis et al. 2005).

Fig. 17.58 A patient with disseminated intravascular coagulation and severe haemorrhage 6 years after surgery with a large macular hole and silicone oil in situ

Fig. 17.59 This patient had a cataract removed in infancy to reveal a posterior persistent hyaloid artery which was seen as a membrane from the optic disc to the back of the lens. There was dragging of peripheral ciliary pigment epithelium into the membrane at its anterior end

17.11 Retinal Prosthesis

Retinal electrodes are being designed and trailed in patients with retinitis pigmentosa. As yet a definitive design has not been established, but early systems have shown encouraging results for levels of vision, for example, 16 pixels (Yanai et al. 2007; Roessler et al. 2009).

17.12 Summary

The rarity of some of these conditions means that exact patterns of clinical care have not been well defined. It is up to the surgeon to develop experience over years and to use this to best manage these patients. Use the principles applied to the commoner conditions as a guide, but be aware there are differences in the rarer conditions in how they will respond to surgery.

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