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Daniel Barthelmes, Matthias Haenggi, Tobias Merz, Jukka Takala, Michael Lensch, Stephan Jakob; A prospective study on Terson’s syndrome and intraocular infections in critically ill patients. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5756.
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To assess the incidence of intraocular sequelae (hemorrhages, bacterial and fungal infections) in a high-risk population of patients in an intensive care unit (ICU).
Prospective, non-interventional study over a period of 10 months. Inclusion criteria: severe head injury (Glascow Coma Scale [GCS] score < 9), intracranial hemorrhages (subarachnoidal, subdural, epidural), thrombocyte count <100,000/ml, severe sepsis. Exclusion criteria: ICU stay ≤ 3 days, direct trauma to eye or orbit. Daily fundoscopy, recording of routine clinical parameters, including coagulation parameters, drained cerebrospinal fluid, blood pressure, intracranial pressure, blood glucose, and leukocyte count.
Seventy-eight patients were included; six (7.7%) of them had intraocular hemorrhages (IOH). None had intraocular bacterial or fungal infections. One of 10 (10%) patients with subarachnoidal hemorrhage, 3 of 20 (15%) patients with sepsis and septic shock and 2 of 16 (13%) patients with craniocerebral trauma had IOH. Overall mortality was 14%. Four patients (67%) with IOH but only 8% of patients without IOH died (p=0.0019). In the sepsis and septic shock group only patients with IOH died; there the IOH occurred shortly before death in each case. No predictive factor for IOH could be determined based on the parameters evaluated.
Intraocular infections or hemorrhages occur only in a minority of a high-risk population of ICU patients. Based on current data, general screening for such events cannot be advocated.
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