Abstract
The aim of this study is to investigate the incidence and mortality of Terson syndrome in patients with treated subarachnoid hemorrhage (SAH) in South Korea. In this nationwide, population-based study, we used the National Health Insurance(NHI) database (2011–2015) to identify patients aged ≥18 years. Newly diagnosed non-traumatic SAH, treated using clipping or coil embolization, were identified, and Terson syndrome was defined as newly diagnosed retinal or vitreous hemorrhage within 3 months of SAH diagnosis. We identified 22,864 patients with treated SAH (tSAH), 196 of whom had Terson syndrome, with the cumulative incidence during 5 years of 0.86% (95% CI: 0.74–0.98): 1.10% (95% CI: 0.88–1.33) in men and 0.71% (95% CI, 0.58–0.85) in women. The cumulative incidence of Terson syndrome in patients aged under 40 was higher than in those aged 40 or over (1.41% vs. 0.81%; p = 0.007). The mortality rate of Terson syndrome in patients with tSAH was not different from that in those without Terson syndrome (4.08% vs. 7.30%; p = 0.089). This was the first nationwide epidemiological study of Terson syndrome using a population-based database. The incidence of Terson syndrome in patients with tSAH was higher in those age under 40 than in those aged 40 or over.
Highlights
Terson syndrome is characterized by intraocular hemorrhage, such as vitreous, sub-hyaloid, or intraretinal/ sub-internal limiting membrane hemorrhage, associated with subarachnoid hemorrhage (SAH)[1]
The cumulative incidence of Terson syndrome in the total population of patients with non-traumatic treated SAH (tSAH) during 5 years was 0.86%: 1.10% in men and 0.71% in women
The age distribution of treated non-traumatic SAH differed from that of Terson syndrome: tSAH tended to be more common in middle age, showing distribution pattern that was similar to normal distribution, while Terson syndrome showed a higher incidence in patients under middle age (Fig. 1)
Summary
Terson syndrome is characterized by intraocular hemorrhage, such as vitreous, sub-hyaloid, or intraretinal/ sub-internal limiting membrane hemorrhage, associated with subarachnoid hemorrhage (SAH)[1]. In several previous single-institution studies, the incidence of Terson syndrome among patients with SAH was 2.5%–40.5%2,3,6,7. The National Health Insurance (NHI) database in South Korea includes information on the total population and provides big data, including information on disease occurrence and treatment in the entire population. For this reason, the database allows researchers to obtain population-based, epidemiological data about Terson syndrome. The current study used the NHI database to investigate (1) the incidence of and mortality from Terson syndrome in patients with treated SAH (tSAH), (2) the percentage of patients with tSAH who underwent ocular examination, and (3) the percentage of patients with Terson syndrome who have undergone vitrectomy in South Korea
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