Prognostic Factors Affecting Visual Recovery in Terson Syndrome with Aneurysmal Subarachnoid Hemorrhage

Abstract

Background: The purpose of this study was to survey the anatomical angiographic finding of the aneurysm and identify parameters associated with visual recovery of the patients with Terson syndrome (TS). Methods: This retrospective study was conducted on 494 patients with aneurysmal subarachnoid hemorrhage (SAH) from 2008 to 2015. Radiologists independently reviewed findings on computed tomography scans and cerebral digital subtraction angiography. Ophthalmologists conducted ophthalmological examinations for patients who had no communication problem. The degree of visual acuity recovery (DVAR) was measured based on the visual acuity difference between the initial and sixth-month follow-up. Favorable visual recovery was defined as DVAR >0.4. Results: A total of 494 patients diagnosed with aneurysmal SAH were given admission to a single institute, of whom 171 received ophthalmological examinations. Of the total, 40 patients were diagnosed with TS and 54 eyeballs were affected by vitreous or retinal hemorrhage. In the multivariable analysis, male sex (odds ratio [OR] 9.530: 95% confidence interval [CI] 1.824-49.801), favorable Glasgow coma scale (GCS) (≥13 points) (OR 8.073: 95% CI 1.226-53.148), and anterior orientation of aneurysm (OR 5.006: 95% CI 1.842-29.751) were identified as independent factors predicting favorable visual recovery after adjusting covariables. Conclusion: TS was identified in 23.4% of patients with aneurysmal SAH. Male sex, favorable GCS at admission, and anterior orientation of the aneurysm were identified as prognostic factors for favorable visual recovery. It is proposed that positive ophthalmologic consultation and treatment can be helpful in improving vision and quality of life of TS patients.