Purpose
To evaluate visual outcomes after vitrectomy for intraocular hemorrhages secondary
to traumatic brain injury.
Design
Retrospective, observational case series.
Participants
A total of 28 eyes in 20 patients undergoing vitrectomy for Terson syndrome secondary
to traumatic brain injury between 1997 and 2015.
Methods
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.
Main Outcome Measures
The primary outcome measure was the change in the preoperative visual acuity score
at postoperative month 1 and at the last noted clinic appointment.
Results
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.
Conclusions
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.
Abbreviations and Acronyms:
BCVA ( best-corrected visual acuity), logMAR ( logarithm of the minimum angle of resolution)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: November 03, 2016
Accepted:
September 12,
2016
Received in revised form:
August 31,
2016
Received:
July 12,
2016
Footnotes
Supplementary video is available online at www.aaojournal.org.
Financial Disclosure(s): The author(s) have made the following disclosure(s): R.N.: Consultant – Allergan, Novartis, Bayer, and Iridex.
A.T.: Consultant – Bausch & Lomb, Synergetics USA, and Allergan; Payment for lectures – Allergan; Royalties – Synergetics USA.
Supported by a Research to Prevent Blindness Physician Scientist Award (to R.S.A.); an unrestricted grant from Research to Prevent Blindness to the Washington University Department of Ophthalmology, Washington University in St. Louis School of Medicine; and the Jeffrey Fort Innovation Fund.
Author Contributions:
Conception and design: Narayanan, Taylor, Apte
Data collection: Narayanan, Taylor, Nayaka, Deshpande, St. Aubin, Hu, Rajagopal, Tewari, Apte
Analysis and interpretation: Narayanan, Taylor, Apte
Obtained funding: Not applicable
Overall responsibility: Narayanan, Taylor, Apte
Identification
Copyright
© 2016 by the American Academy of Ophthalmology
