Dec 15, 2016
Breakthrough Surgery Restores Sight to People With Hemorrhaging in the Eye
Somewhere along the way, a medical professional had made the assumption that the young man's blindness was the result of his brain injury, and so he'd never been examined by an ophthalmologist — that is, until his family brought him to see Dr. Apte at Washington University.
"This patient, when I first saw him, he didn't speak anything. He was very quiet. The dad did most of the talking," Dr. Apte told Seeker. "Emotionally, he'd become a different person because of everything that had happened."
During the examination, Dr. Apte saw that in both eyes, the vitreous fluid, the gel that fills the space between the lens and the retina, had hemorrhaged and that blood had gotten into the space. He wondered if the man was blind, not because of damage to his brain's visual cortex, but because of a medical condition called Terson syndrome.
This syndrome sometimes afflicts people who have blood in their brain from a ruptured aneurysm. The blood and pressure that builds up in the brain can cause blood vessels around the eye's optic nerve to also burst, filling the eye with blood and preventing light from reaching photoreceptor cells in the retina. The same thing can happen to victims of severe trauma like car accidents.
Dr. Apte suggested doing a vitrectomy, a type of surgery that typically replaces the vitreous gel with saline solution. But in this case, the doctor would clean out the blood, which had coagulated in the six months since the accident, and replace it with saline solution. There was no guarantee it would work, he told family. And six months was a long time. They agreed.
A day after the surgery, the man could read Dr. Apte's eye chart — not just the top line, but down toward the bottom.
"It was pretty incredible," Dr. Apte said. "He just wouldn't stop talking. He was very animated and very excited. As soon as I saw him, the first thing he asked me was, 'When are we going to do surgery on the other eye?'"
He ended up seeing perfectly well in both eyes.
It was the first time Dr. Apte had thought that he should look more closely at the success rates of surgeries done on patients with Terson syndrome secondary to trauma. The idea stayed with him in the intervening years and when he had the opportunity to conduct an assessment, he did it.
This week, Dr. Apte, now a distinguished professor of ophthalmology and visual sciences at Washington University School of Medicine and his colleagues from Wayne State University in Detroit and the L.V. Prasad Eye Institute in India, report in the journal Ophthalmology on 20 different patients with Terson syndrome from three different medical institutions.
In some cases, both eyes had experienced hemorrhaging and in other cases, only one eye had. In total, the researchers looked at 28 eyes. They also divided the patients into two groups: those who'd had the vitrectomy within three months and those who'd had surgery after three months.
Some were legally blind prior to the surgery as a result of their injuries, but within a month of the procedure, had regained their vision. After a few months later, almost everyone had 20/20 vision. Dr. Apte stressed that the surgery won't return vision to patients who had vision loss from unrelated reasons before an accident.
Overall, the analysis was reassuring, Dr. Apte said. "Even if you have to wait for the surgery for several months, the outcomes were still good."
Read more at Discovery News