Terson's syndrome. Clinicopathologic correlations

In seven cases of Terson's syndrome, an elevated, dome-shaped, membrane was detected in the posterior pole by ophthalmoscopy, echography, or during pars plana vitrectomy. Light and electron microscopic examination of two additional eyes obtained postmortem from an acute case of Terson's syndrome revealed that the posterior vitreous face was elevated by blood and that the internal limiting membrane of the retina was intact and in its normal position. In two chronic cases, a dome-shaped epiretinal membrane was excised from the macula during vitrectomy. Light and ultrastructural studies demonstrated that the membranes consisted of glial cells and basement membrane material. The dome-shaped structure observed in eyes with Terson's syndrome is due to the formation of a subhyaloid hemorrhage. The partially detached posterior hyaloid face created by this hemorrhage provides a scaffold for cellular proliferation and the development of an elevated epiretinal membrane in long-standing cases. Echographically, this membrane resembles a retinal detachment in B-scans, but can be clearly distinguished from retina with standardized A-scan.