| Department of Ophthalmology, Catholic Kwandong University, Incheon, Republic of Korea (1), Department of Neurosurgery, Catholic Kwandong University, Incheon, Republic of Korea (2) |
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Purpose : To investigate the clinical characteristics of Terson syndrome, using multi-modal imaging analysis.
Methods : This retrospective case series included a total 31 patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent ophthalmologic screening for Terson syndrome. We reviewed and evaluated the findings from multi-modal imaging analysis, including ultra-wide fundus photography (UWF), fluorescein angiography (FA), spectral domain optical coherence tomography (SD OCT), and fundus autofluorescence (FAF) images, conducted on patients with Terson syndrome. The main outcome measure was abnormal findings from multi-modal imaging studies in patients with Terson syndrome.
Results : Of the 31 patients analyzed, 16 showed (51.6%) fundus abnormalities, and 10 patients (32.3%) were ultimately diagnosed with Terson syndrome. Fundus examination revealed multi-layered retinal hemorrhages, characteristic of this disease. Increased tortuosity of perifoveal capillaries and microaneurymal changes were noted in FA analysis, and in addition, varying degrees of disc leakage were also observed. SD OCT allowed the anatomical localization of multi-layered retinal hemorrhages and assessment of photoreceptor ellipsoid zone integrity, both at the time of diagnosis and during the follow-up period. FAF images revealed hypo-autofluorescent lesions, corresponding to multi-layered retinal hemorrhages at the time of diagnosis, which then resolved spontaneously, concurrent with the resolution of retinal hemorrhages, during the follow-up period. However, in some patients these hypo-autofluorescent lesions corresponding to subretinal hemorrhage were not completely resolved. Lastly, we observed other fundus abnormalities in six patients who did not meet the clinical definition of Terson syndrome, including cotton-wool spots and unilateral retinal hemorrhage.
Conclusion : Multi-modal imaging analysis showed characteristic features of Terson syndrome, as well as previously unreported clinical manifestations, and these data may help to improve our understandings of this complex disease.
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