title: Late ophthalmological assessment of patients with subarachnoid hemorrhage and clipping of cerebral aneurysm.
abstract: OBJECTIVE
  To estimate prospectively late ocular manifestations in patients after aneurysmal subarachnoid hemorrhage (SAH) treated with aneurysm clipping.
  
  
  METHODS
  Forty-six patients (12 men and 34 women), 23-69 years of age, were included in this study. A conventional ophthalmological examination, visual evoked potentials (VEPs), and static perimetry were performed on all patients. The mean interval between the onset of SAH and the aforementioned examination was 1.9 ± 1.3 years (range 0.5-5 years). The following were compared between patients with affected and non-affected visual fields as well as between those with normal and abnormal VEPs: sex, age, time from SAH to surgery, Hunt and Hess scale, Glasgow Coma Scale, Glasgow Outcome Scale, grading of SAH according to the Fisher scale, and the size and site of aneurysm.
  
  
  RESULTS
  Visual field defects were found in 23 patients (50%). In all of these patients, both eyes were affected. The most frequent type of visual field defects were: constricted field (47.8%), multiple peripheral foci (26.1%), and superior field defect (17.4%). There was no significant relationship between the analyzed factors and the occurrence of visual field defects, although statistical significance was almost observed in respect to the Fisher scale (p = 0.055). Deterioration in VEPs was observed in nine patients (19.6%). In the group of patients with abnormal VEPs, the time from onset of SAH to surgery was 2.6 ± 1.8 days, whereas in the group of patients with normal VEPs this time amounted to 6.4 ± 2.4 days (p = 0.02). In patients with no changes in VEPs, the mean Fisher score was significantly higher than in the group with abnormal VEPs (2.8 ± 0.6 vs 2.0 ± 0.4 respectively, p = 0.04).
  
  
  CONCLUSIONS
  Visual field defects and VEP deterioration are frequent late ocular manifestations of SAH treated with aneurysm clipping. Damage to the visual pathway correlates with the severity of SAH and timing of aneurysmal surgery.
authors.affiliation: Department of Ophthalmology, Medical University of Bialystok, Poland. iwonaobu@wp.pl
authors.forename: Iwona
authors.initials: I
authors.lastname: Obuchowska
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Turek
authors.forename: Zenon
authors.initials: Z
authors.lastname: Mariak
authors.forename: Jan
authors.initials: J
authors.lastname: Kochanowicz
authors.forename: Zofia
authors.initials: Z
authors.lastname: Mariak
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D013525:Surgical Instruments / Q000009:adverse effects; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D014786:Vision Disorders / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D014795:Visual Pathways / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult