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  • Bedside Optical Coherence Tomography for Terson’s Syndrome screening in Acute Subarachnoid Hemorrhage: A pilot study.

    Final Number:

    Ciro Ramos Estebanez MD, PhD; Maryo Kohen MD; Jonathan Pace MD; Alirezi Bozorgi MD; Sunil Manjila MD; Vilakshan Alambyan MD; Ifeyinwa Nwankwo MD; Michael DeGeorgia MD; Nicholas C. Bambakidis MD; Faruk Orge MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting - Late Breaking Science

    Introduction: Our goal was to evaluate the feasibility and potential role of bedside optical coherence tomography (OCT) in Terson’s Syndrome (TS) in patients with acute subarachnoid hemorrhage (aSAH) and its potential role in blindness prevention.

    Methods: Open label pilot study: 31 patients with angiographic diagnosis of aSAH were first screened for TS with dilated fundoscopy and then with OCT in the acute phase and at 6-week follow-up visits.  Outpatient mood assessments (PHQ-9, HDS), and quality of life general (NIH-PROMIS) and visual scales (VFQ-25) were measured at 1 and 6 weeks after discharge. Exclusion criteria included current or previous history or severe cataracts, severe diabetic retinopathy, severe macular degeneration, or glaucoma.

    Results: OCT identified 7 patients (22.6% incidence of TS in our aSAH sample: 7 in the acute phase, a large retinal detachment was initially missed by fundoscopy and diagnosed by OCT in follow up clinic). Dilated retinal fundoscopy significantly failed to detect TS (n=4, 57.1% missed cases). IVH was significantly more incident in TS cases (85.7% vs. 25%). None of the participants experienced any complications from OCT examinations. At follow-up 6 weeks after discharge, neither decreased quality of life visual scale scores nor a depressed mood correlated with objective OCT pathological findings. There were no significant mood differences between TS cases and controls.

    Conclusions: OCT is the gold-standard in retinal disease diagnosis. This pilot study shows that bedside OCT examination is feasible in aSAH. In our series, OCT was a safe procedure that enhanced TS detection by decreasing false negative/ inconclusive fundoscopic examinations. It allows early diagnosis of macular holes and severe retinal detachments, which require acute surgical therapy to prevent legal blindness. Besides, OCT aids ruling out potential false positive visual deficits in individuals with a depressed mood at follow up.

    Patient Care: This study details how OCT allows for early diagnosis of macular holes and severe retinal detachments, which require acute surgical therapy to prevent legal blindness. Further, OCT aids ruling out potential false positive visual deficits in individuals with a depressed mood at follow up.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss Terson's Syndrome, and its impact on vision in patients with subarachnoid hemorrhage 2) Discuss the implementation of bedside Optic Coherence Tomography in the diagnosis of Terson's Syndrome 3) Identify patients requiring urgent surgical treatment for Terson's Syndrome, to prevent legal blindness for the patients

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