Breakthrough Surgery Restores Sight to People With Hemorrhaging in the Eye
Patients who were legally blind as a result of brain injuries regained their vision after surgery.
It's been ten years or so, but Dr. Rajendra Apte remembers the patient vividly: a young man who'd gone blind after being struck by a car while jogging. The 20-year-old graduate school student had suffered multiple injuries, brain trauma and had undergone numerous surgeries to get to a point where he could finally walk again, if only with assistance.
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.
WATCH VIDEO: How Do the Blind Perceive the World?
"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."
That information is useful to doctors counseling a patient about whether or not to undergo surgery.
The study is also important neurologists and neurosurgeons, who see brain trauma patients in the early stages of treatment. Knowing that bleeding in the brain can lead to Terson syndrome, which can lead to blindness could help establish a new protocol for calling in an ophthalmologist.
Ten years ago, that did not happen, when Dr. Apte met the young graduate student that lead to this research project.
He hasn't seen that man in years. "But that's a good sign, right? It means he doesn't need me anymore."