Dataset Information

Hemorrhagic Macular Cysts in Patients with Terson's Syndrome Observed through an Ophthalmic Surgical Microscope.

ABSTRACT: The characteristics of hemorrhagic macular cysts (HMCs) in patients with Terson's syndrome, focusing on the vitreoretinal interface observed through an ophthalmic surgical microscope, are described. Between May 2015 and February 2022, 19 eyes (17 patients) with vitreous hemorrhage (VH) occurring after subarachnoid hemorrhage underwent pars plana vitrectomy. After removing dense VH, 2 of 19 eyes had HMCs. In both cases with HMCs, they formed a dome-like shape and were located beneath the internal limiting membrane (ILM), lying beyond the clean posterior precortical vitreous pocket (PPVP) without hemorrhage despite the severe VH. Based on the microsurgical findings, it appears that two types of HMCs consisting of subhyaloid and sub-ILM hemorrhages in Terson's syndrome may be involved in the impairment of adhesion of the posterior border of the PPVP and the ILM surface of the macula due to micro bleeding, and that the PPVP may prevent the sub-ILM type of HMC from breaking into the subhyaloid space and transforming into the subhyaloid type. In conclusion, the PPVP may play an important role in the formation of HMCs in Terson's syndrome.

SUBMITTER: Hanai K

PROVIDER: S-EPMC9944200 | biostudies-literature | 2022 Sep-Dec

REPOSITORIES: biostudies-literature

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Hemorrhagic Macular Cysts in Patients with Terson's Syndrome Observed through an Ophthalmic Surgical Microscope.

Hanai Kaori K Hashimoto Masato M Nakamura Hirohiko H

Case reports in ophthalmology 20220930 3

The characteristics of hemorrhagic macular cysts (HMCs) in patients with Terson's syndrome, focusing on the vitreoretinal interface observed through an ophthalmic surgical microscope, are described. Between May 2015 and February 2022, 19 eyes (17 patients) with vitreous hemorrhage (VH) occurring after subarachnoid hemorrhage underwent pars plana vitrectomy. After removing dense VH, 2 of 19 eyes had HMCs. In both cases with HMCs, they formed a dome-like shape and were located beneath the internal ...[more]

PMID: 36845459

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Project description:ObjectiveIn this study, we aimed to characterize the frequency and distribution of ocular surgeries in patients with inherited retinal diseases (IRDs) and evaluate associated patient and disease factors.DesignRetrospective cohort.ParticipantsSubjects aged ≥ 18 years who were followed at the Johns Hopkins Genetic Eye Disease Center.MethodsWe studied a retrospective cohort of patients with an IRD diagnosis to analyze the occurrence of laser and incisional surgeries. Subjects were categorized into 2 groups: central dysfunction (macular/cone/cone-rod dystrophy, "MCCRD group") and panretinal or peripheral dysfunction (retinitis pigmentosa-like, "RP group"). Genetic testing status was recorded. The association of patient and disease factors on the frequency, distribution, and timing of surgeries was analyzed.Main outcome measuresPrevalence, prevalence odds ratio (POR), hazard ratio (HR) of ophthalmic procedures by phenotype.ResultsA total of 1472 eyes of 736 subjects were evaluated. Among them, 31.3% (n = 230) had undergone ocular surgery, and 78.3% of those (n = 180/230) had a history of more than 1 surgery. A total of 602 surgical procedures were analyzed. Cataract extraction with intraocular lens implantation (CEIOL) was the most common (51.2%), followed by yttrium aluminum garnet capsulotomy, refractive surgery, retinal surgery, and others. Cataract extraction with intraocular lens implantation occurred more frequently in RP than in MCCRD subjects (POR, 2.59; P = 0.002). Retinitis pigmentosa subjects underwent CEIOL at a younger age than patients with MCCRD (HR, 2.11; P < 0.001).ConclusionsApproximately one-third of patients with IRD had a history of laser or incisional surgery. Cataract extraction with intraocular lens implantation was the most common surgery; its frequency and timing may be associated with the IRD phenotype. This data may inform the design of prospective research. Such efforts may illuminate routine clinical decision-making and contribute to surgical strategy development for cell and gene therapy delivery.Financial disclosure(s)Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Project description:Background and objectiveWhether and when surgical intervention is indicated for mediastinal cysts is a matter of some debate. While most mediastinal cysts are found incidentally, the anatomic location, clinical presentation, and symptoms, as well as the potential for malignancy, are important considerations that inform decisions related to whether to intervene surgically. The objective of this review is to summarize the current literature regarding the criteria for surgical excision of mediastinal cysts and provide a framework for the clinician and surgeon to arrive at a decision regarding the appropriateness of surgical intervention of mediastinal cysts.MethodsA review of the published literature in the last 45 years (1977-2022) was conducted through PubMed, MeSh and Google Scholar. We included retrospective reviews, meta-analyses, and case studies published in the English language. A single author identified eligible studies, and those identified were reviewed by the team until consensus was met. Pediatric literature was excluded from this review.Key content and findingsThe current literature predominantly contains case studies, small retrospective studies, and meta-analyses describing mediastinal cysts. In the anterior mediastinum, multiloculated thymic cysts should be resected to rule out thymic malignancy. Intralesional fat, smooth borders, and a more midline location are features suggestive of a benign process, while asymmetric cystic wall thickening has been associated with malignancy. Both esophageal and bronchogenic cysts should be excised, taking into account the risk of complications (up to a 45% risk) of infection, rupture, or compression, as well as the rare risk of associated malignancy. Simple thymic and small pericardial cysts can be observed and followed with serial radiographic tools and should be resected if they increase in size, compress surrounding structures, or lead the patient to develop symptoms.ConclusionsSince mediastinal cysts are rare and often asymptomatic, there are no formal guidelines outlining when surgical intervention should be undertaken. Based on our review of the literature, surgical intervention should be pursued if the patient's symptoms correlate with radiographic findings of a mediastinal cyst, there is compression of the surrounding structures, and concern of malignancy is present.

Dataset Information

Hemorrhagic Macular Cysts in Patients with Terson's Syndrome Observed through an Ophthalmic Surgical Microscope.

Publications

Hemorrhagic Macular Cysts in Patients with Terson's Syndrome Observed through an Ophthalmic Surgical Microscope.

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