太尔松(Terson)综合征手术效果及发病机制

The surgery efficacy and pathogenesis of Terson syndrome

目的分析太尔松(Terson)综合征手术效果及发病机制。方法回顾性分析山西医科大学第一医院2017年9月至2019年10月玻璃体切除术治疗Terson综合征10例(18眼)的临床资料,比较术前与术后视力、不同的手术时机与疗效的关系,分析Terson综合征的发病机制。结果术后1个月视力(BCVA,log MAR)为0.36±0.28,优于术前的2.78±0.43(t=20.12,P<0.05)。短病程组(<3个月)术后视力(BCVA,log MAR)为0.36±0.19,优于长病程组(≥3个月)的0.74±0.22(t=13.480,P=0.008)。术中发现所有病例具有高度相似的临床特征,如早期的黄白色圆丘形病灶和晚期的近圆形病灶,以视盘为起始、以Cloquet管为中心的条状出血及浑浊等。结论玻璃体切除术治疗Terson综合征可以显著改善视力。手术越早视力提高越显著。由眼底病变推断其发病可能是颅高压导致血液沿视神经突破筛板后进入玻璃体和(或)视网膜静脉回流受阻导致小静脉及毛细血管破裂所致。

Objective To analyze the surgery efficacy and the pathogenesis of Terson syndrome.Methods The clinical data of 18 eyes of 10 patients with Terson syndrome treated with vitrectomy from Sep.2017 to Oct.2019 in the First Hospital of Shanxi Medical University were analyzed retrospectively.Preoperative and postoperative visual acuity were compared.The relations between the different surgical timing and efficacy were compared,and the pathogenesis of Terson syndrome were analyzed.Results The visual acuity(BCVA,log MAR)of all patients at 1 month postoperatively was 0.36±0.28,which was better than the 2.78±0.43 before surgery(t=20.12,P<0.05).The postoperative visual acuity of the shorter course group(<3 months)was 0.36±0.19,which was better than the 0.74±0.22 of the longer course group(≥3 months)and the difference was statistically significant(t=13.480,P=0.008).Introperatively,all cases were found to have highly similar clinical features,such as yellow-white domes in the early stage and similar near-round lesions in the late stage,strip bleeding and opacity starting from the optic disc and centered on Cloquet’s canal.Conclusion Vitrectomy for Terson syndrome can effectively improve visual acuity.The early surgery is performed,the better vision is achieved.According to the fundus diseases,it is speculated that the pathogenesis of Terson syndrome may be caused by intracranial hypertension leading to the blood penetrating the lamina cribrosa sclerae into vitreous body or the rupture of the retinal venula and capillaries because of venous occlusion.