Visual Outcomes after Vitrectomy for Terson Syndrome Secondary to Traumatic Brain Injury.
To evaluate visual outcomes after vitrectomy for intraocular hemorrhages secondary to traumatic brain injury.



Retrospective, observational case series.



A total of 28 eyes in 20 patients undergoing vitrectomy for Terson syndrome secondary to traumatic brain injury between 1997 and 2015.



We reviewed the records of patients undergoing a standard 20-gauge or 23-gauge pars plana vitrectomy for intraocular hemorrhages secondary to traumatic brain injury, and the timing of vitrectomy in relation to the inciting intracranial event was recorded.



The primary outcome measure was the change in the preoperative visual acuity score at postoperative month 1 and at the last noted clinic appointment.



A total of 28 eyes in 20 patients (all male) underwent pars plana vitrectomy for intraocular hemorrhages secondary to traumatic brain injury. The mean preoperative baseline logarithm of the minimum angle of resolution (logMAR) (Snellen) best-corrected visual acuity (BCVA) was 1.81±0.56 (20/1290). At 1-month postoperative follow-up, the mean BCVA was 0.30±0.33 (20/40). At the date of the last follow-up, the mean BCVA was 0.15±0.24 (20/30) and the median BCVA was 0.00 (20/20). Although the difference between preoperative and postoperative BVCA was significantly different at 1 month and the final postoperative clinic visits (P < 0.001), there was not a correlation between preoperative visual acuity as a predictor of final postoperative visual acuity outcome (r=-0.32; P = 0.09; 95% confidence interval [CI] -0.62 - 0.06). At the date of the last follow-up, the differences in visual outcomes between the individuals undergoing vitrectomy within 3 months of the inciting event, 0.08±0.15 (20/25), were not significantly different than those undergoing surgical intervention after 3 months, 0.18±0.27 (20/30) (P = 0.28). Three cases among those undergoing vitrectomy after 3 months were complicated by retinal detachment, none of which resulted in a BCVA worse than when the patient originally presented preoperatively.



In this retrospective series of patients without other ocular pathology, surgical intervention effectively provided rapid visual recovery in the majority of individuals with intraocular hemorrhages secondary to traumatic brain injury, irrespective of the timing of vitrectomy or of preoperative visual acuity.
L.V. Prasad Eye Institute, Hyderabad, India.
Raja
R
Narayanan
Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri.
Stanford C
SC
Taylor
L.V. Prasad Eye Institute, Hyderabad, India.
Ashraya
A
Nayaka
L.V. Prasad Eye Institute, Hyderabad, India.
Riddhima
R
Deshpande
Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan.
Daniel
D
St Aubin
Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri.
Frank N
FN
Hrisomalos
Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan.
Jonathan
J
Hu
Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri.
Rithwick
R
Rajagopal
Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan.
Asheesh
A
Tewari
Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri. Electronic address: Apte@vision.wustl.edu.
Rajendra S
RS
Apte
D000293:Adolescent; D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012163:Retinal Detachment / Q000209:etiology; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000379:methods*; D014823:Vitreous Hemorrhage / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult