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Factors affecting anatomical and visual outcomes in Terson syndrome managed by surgery or observation

Eye (2024)Cite this article

Subjects

Abstract

Objectives

To investigate visual outcomes and prognostic factors of patients with Terson syndrome (TS) managed with observation or pars plana vitrectomy (PPV).

Methods

retrospective review of medical records of 117 eyes from 81 patients (43 females) with TS. Main outcome measures were final best corrected visual acuity (BCVA), intraoperative findings and long-term sequelae.

Results

46 (39.3%) eyes were managed conservatively and 71 (60.7%) eyes underwent PPV. Median follow-up was 8.4 months. The PPV group had significantly worse (p < 0.001) baseline BCVA (median 2.3 versus 0.7 logMAR, Snellen equivalent 20/4000 versus 20/100). Final BCVA did not differ between the two groups (p = 0.38). Final BCVA ≥ 0.3 logMAR (20/40) in the surgery group was associated with post-operative retinal detachment (p = 0.013) and macular abnormalities (p = 0.014), and in the observation group with ocular comorbidity (p = 0.008). Retinal breaks were detected intraoperatively in 25 (35.2%) eyes and were associated with an interval longer than 3 months between ocular diagnosis and surgery (p = 0.04), but not with larger gauge instrumentation and posterior vitreous detachment. Incidence of ERM did not differ among patients managed conservatively and after PPV (p = 0.9) and between eyes undergoing early or delayed surgery (p = 0.09). The most common post-operative complications were cataract in 16 (22.5%) eyes and ERM in 8 (11.3%) eyes.

Conclusions

visual outcomes in TS are similar with both management strategies. Surgery allows faster and greater visual recovery but carries high risk of intraoperative retinal tears if delayed for longer than 3 months from initial presentation. ERM and retinal detachment are not correlated with timing of surgery or management strategy.

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Data availability

Data supporting the findings of the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

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Authors and Affiliations

  1. Royal Berkshire Hospitals NHS Foundation Trust, London Road, Reading, RG1 5AN, UK

    Beatrice Gallo, Ramy Khader & Evgenia Anikina

  2. Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK

    Julia Fajardo-Sanchez, Paul Sullivan & Evgenia Anikina

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  1. Beatrice Gallo
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  4. Paul Sullivan
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Contributions

Study concept and design: EA and PS. Acquisition, analysis and interpretation of data: BG, RK, JFS. Drafting the manuscript and critical revision for important intellectual content: BG, EA, PS. Final approval of the version to be published: all authors.

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Correspondence to Beatrice Gallo.

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Gallo, B., Khader, R., Fajardo-Sanchez, J. et al. Factors affecting anatomical and visual outcomes in Terson syndrome managed by surgery or observation. Eye (2024). https://doi.org/10.1038/s41433-024-03113-1

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