Referral delay and ocular surgical outcome in Terson syndrome.

BACKGROUND: In Terson syndrome, vitreous hemorrhage can result from intracranial hypertension associated with intracranial bleeding. The vitreous hemorrhage can cause a considerable visual handicap. The aim of this study was to determine the outcome of surgery in patients with Terson syndrome and any delay in referral to an ophthalmologist. METHODS: Retrospective case review of 25 eyes of 17 patients undergoing vitrectomy for Terson syndrome. Delay in presentation to an ophthalmologist, intraoperative and postoperative complications, and the final visual acuity were noted. RESULTS: The mean interval between visual symptoms and referral to an ophthalmologist was 5.2 months for the nine unilateral cases and 4.9 months for the eight bilateral cases. Intraoperative complications included retinal break (2) and retinal dialysis (3). Late complications included epiretinal membrane (4), ghost cell glaucoma (1), and cataract (8). Twenty-two of the 25 eyes achieved a final visual acuity of 20/30 or better. CONCLUSION: Vitrectomy for vitreous hemorrhage in Terson syndrome is a safe and effective procedure, offering a rapid and prolonged improvement in vision. There is good reason to consider early vitrectomy, particularly when the hemorrhage is bilateral and dense.

The treatment of bullous rhegmatogenous retinal detachment.

We describe the results of a consecutive series of 97 cases of bullous superior retinal detachment treated by conventional surgery. The retinal detachments were characterized by either a single retinal break or multiple retinal breaks confined within 1 clock hour and no proliferative vitreoretinopathy. The surgery involved sequential drainage of subretinal fluid, injection of air, cryotherapy and the application of local explant. All cases would otherwise be suitable for pneumatic retinopexy. The anatomical success rate was 85.5% with a single operation and 97% with further procedures. We report on the complications encountered and appraise the advantages and disadvantages of this operation. Forty-five of the 97 cases had detachment of the macula for less than 2 weeks, and 35 of the 45 (80%) achieved a visual acuity of 6/18 or better. These visual results challenge the assertion that better visual outcome might be attained with pneumatic retinopexy.

Results and complications of conventional repair of bullous retinal detachment using posterior segment air injection.

The aims of this retrospective study were to determine the outcome of retinal detachment repair using the drainage, air injection, cryotherapy and explant surgical sequence ('D-ACE' technique) for bullous retinal detachments and also to identify the complications attributable to the injection of the gas. The D-ACE technique was used to repair 206 detachments over a ten year period of which 138 (67%) were successfully re-attached with a single operation. The sub-group of these patients (n = 66) with bullous retinal detachments who would be considered suitable for repair using the technique of pneumoretinopexy (PR) showed a single operation success rate of 85% after D-ACE. Complications attributable to the gas injection occurred in 18 eyes (8.5%). In only four of these (1.9%) did retinal surgery ultimately fail as a result of complications caused by injection of the gas, which represents 10% of all the failures. The results of this series show that the serious complication rate from injecting air into the vitreous cavity is low and that the success rate for treating relatively uncomplicated bullous retinal detachments using the D-ACE technique compares favourably with the results of other published series using either the D-ACE procedure or pneumoretinopexy.

Blood pressure and the progression of mild background diabetic retinopathy.

A retrospective 5-year study examined the relationship between blood pressure and the severity and progression of mild background retinopathy in 48 patients with non-insulin-dependent diabetes and 38 with insulin-dependent diabetes who did not receive treatment in either eye for at least 3 years from their initial visit. All patients had annual medical and ophthalmic examinations including fundus photography. Retinopathy was assessed from fundus photographs using the Hammersmith grading system. Initial mean systolic and diastolic blood pressures (mm Hg) were significantly higher in those with non-insulin-dependent diabetes (149/88) than in patients with insulin-dependent diabetes (129/81). The former had significantly worse retinopathy than the latter initially and at 5 years. When non-insulin-dependent patients were grouped according to systolic blood pressure, those with readings above 160 mm Hg had significantly more severe retinopathy than those with readings below 140 mm Hg. Blood pressures initially and at 3 years were not significantly different between patients who received photocoagulation (five with insulin-dependent and six with non-insulin-dependent diabetes and those who did not in either group. There was significant correlation between systolic blood pressure and severity of retinopathy in patients with non-insulin-dependent disease, but the change in severity of retinopathy at 5 years did not correlate with blood pressure in either group.

Natural history of peripheral neovascularisation in diabetic retinopathy.

A study of 62 untreated eyes of 54 diabetic patients with peripheral neovascularisation is reported. The study shows that neovascularisation rarely remains confined to one sector of the retina; 18% of eyes had developed disc new vessels within one year, 27% had a vitreous haemorrhage within five years, and 10% developed either macular traction or a retinal detachment.

Photocoagulation for peripheral neovascularisation in diabetes.

A study of 90 eyes in 72 diabetic patients with peripheral retinal neovascularisation treated by photocoagulation indicated that the subsequent development of further peripheral or disc new vessels is infrequent if panretinal photocoagulation is the initial treatment procedure. Focal or sectorial treatment may be considered only if a small area of neovascularisation is present initially and provided regular follow-up can be guaranteed.