婴幼儿Terson综合征的临床分析

Clinical analysis of Terson syndrome in infants

目的探讨婴幼儿Terson综合征的临床特点、干预情况、解剖学和视功能的预后及其合理的手术时机。方法回顾性系列病例研究。收集2008年5月至2021年3月于北京大学人民医院眼科诊断为婴幼儿Terson综合征的14例(23只眼)患儿资料。其中男性7例(11只眼),女性7例(12只眼);首诊年龄(4.59±3.96)个月。所有患儿双眼前节未见明显异常。分析患儿基本信息、颅内出血原因、眼内出血的特点、干预情况、解剖学及视功能预后。结果诱因为颅脑创伤者3例、特发性者8例、室管膜囊肿破裂者1例、呼吸窘迫者2例。主诉为行为改变者9例,眼底筛查发现出血者5例。病程<3个月的16只眼中,12只眼有眼内出血相关的合并症;病程≥3个月的7只眼中,6只眼有眼内出血相关的合并症。23只眼中有3只眼(13.04%)给予保守治疗,20只眼(86.96%)行玻璃体切除术(PPV)治疗;随访6~160个月。解剖学预后:眼球萎缩3只眼,视网膜在位18只眼,视网膜脱离2只眼。除外不配合视力检查的3只眼,共收集到20只眼的视力检查结果:较初诊时改善12只眼,保持不变5只眼,恶化3只眼;10只眼出现近视。结论婴幼儿Terson综合征相关眼内出血可遮挡黄斑,引起其结构和功能严重损伤;目前PPV是一种有效的干预方法,可快速清除积血,恢复解剖结构,尽早施行PPV为婴幼儿的视觉发育提供较好的条件。

Objective To observe the clinical features,intervention and outcomes of anatomic and visual functions of Terson syndrome in infants,and to explore the appropriate timing for surgery.Methods This retrospective study included 23 eyes of 14 infants diagnosed with vitreous hemorrhage related to Terson syndrome between May 2008 and March 2021 in Department of Ophthalmology,Peking University People′s Hospital.There were 7 males(11 eyes)and 7 females(12 eyes).The age at the initial visit was(4.59±3.96)months.No obvious abnormality was observed in the anterior segment of both eyes of each patient.Data were collected,including demographics,causes of intracranial hemorrhage,characteristics of intraocular hemorrhage,intervention,outcomes of anatomic and visual functions.Results The causes were craniocerebral trauma in 3 patients,idiopathic cysts in 8 patients,ependymal cyst rupture in 1 patient and respiratory distress in 2 patients.The chief complaint was behavior change in 9 patients,and hemorrhage was found in 5 patients on fundus examination.The rate of complications related to intraocular bleeding was 12/16 when the duration was less than 3 months and 6/7 when the duration was more than 3 months.Twenty eyes(86.96%)were treated by vitrectomy.The follow-up ranged from 6 to 160 months.Three eyes were atrophied,anatomical success was recorded in 18 eyes,and retinal detachment developed in 2 eyes.The visual acuity was improved in 12 eyes(60%),unchanged in 5 eyes(25%),and deteriorated in 3 eyes(15%),except 3 eyes that did not comply with visual acuity examination.Ten eyes showed an obvious myopic shift.Conclusions The vitreous hemorrhage related to Terson syndrome can occlude the macula and cause severe structural and functional impairments in infants.Vitrectomy is an effective intervention technique,which can quickly remove blood accumulation and restore the anatomical structure,providing better conditions for the visual development of infants.