PMC6507114_01
Optos Fundus Photos showing (a) right eye and (b) left eye at presentation showing preretinal hemorrhages, flame hemorrhages, and intraretinal blot hemorrhages with optic disc edema consistent with Terson syndrome. (c, e) Right eye and (d, f) left eye showing disc pallor consistent with optic atrophy and resolving hemorrhages with persistent inferior preretinal hemorrhages inferior to the disc at (c, d) 3-month follow-up and at (e, f) 4-month follow-up.
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fig1
Preretinal and intraretinal hemorrhages were present in both eyes, largely concentrated in the peripapillary retina, but extending to the mid-peripheral retina (Figures 1(a) and 1(b)). Follow-up examinations with serial OCT of the optic nerve showed continued progressive improvement in disc edema (Figures 2(a)-2(h)) along with complete resolution of papilledema and peripapillary hemorrhages (Figures 1(a)-1(f)).
Retina Nerve Fiber Layer (RNFL) Optical Coherence tomography (OCT) of the (a, c, e, g) right eye and (b, d, f, h) left eye showing (a, b) disc edema at presentation, (c, d) improving disc edema at six-week follow-up, and (e, f) near resolution of disc edema at twelve weeks and (g, h) sixteen weeks. Sectoral thickness measured in microns, and thickness of cross-section in temporal (TMP), superior (SUP), nasal (NAS), and inferior (INF) graphed against normative population data set.
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Optic nerve swelling was confirmed on optical coherence tomography (OCT) of the retinal nerve fiber layer (Figures 2(a) and 2(b)). Follow-up examinations with serial OCT of the optic nerve showed continued progressive improvement in disc edema (Figures 2(a)-2(h)) along with complete resolution of papilledema and peripapillary hemorrhages (Figures 1(a)-1(f)).
Fluorescein angiography (FA) taken at six minutes of (a) right and (b) left eye showing disc hyperfluorescence without disc leakage and surrounding peripapillary hemorrhages.
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Fluorescein angiography revealed hyperfluorescence of the optic disc OU (Figures 3(a) and 3(b)).
Humphrey visual field of the patient of the right eye shows scattered deficits both upon presentation (a) and almost one year later (b). A dense superior arcuate defect seen in the left eye on presentation (c) is consistent and has not progressed almost one year later (d). This superior arcuate defect corresponds to inferotemporal thinning of the retinal nerve fiber layer on OCT of the left eye.
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The findings of persistent disc pallor and inferotemporal nerve fiber layer thinning on OCT were consistent with the persistent visual field deficit documented on Humphrey visual fields (Figures 4(a)-4(d)).