A 45-year-old woman was referred from the neurosurgery department due to bilateral sudden vision loss after ventriculoperitoneal shunt surgery of a temporal subdural hygroma and occipital craneal abscess.
All this is the result of a subacute postoperative complication.
Fifteen days before, she had undergone preventive spinal cord compression due to Arnold-Chiari I malformation.
The patient had a clinical course of 16 years, with headaches of mild intensity, instability, rotational dizziness, self-limiting vomiting of variable duration and mild vertical nystagmus for one year.
The latter helped in the suspicion and diagnosis of congenital colitis, since its symptomatology was related to ulcerative colitis that had suffered for years.
Visual acuity (VA) in the first examination was hand movement in both eyes.
Pupilural reactions were 2+ without relative afferent pupillary defect.
He had a sacudide nystagmus towards low frequency and medium amplitude.
The eye fundus showed premacular retrohialoid hemorrhage and bilateral vitreous, confirmed by optical coherence tomography (OCT) and ocular ultrasound.
All these facts were compatible with TS.
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A posterior hyaloidectomy was performed in his right eye (RE) after instillation of anesthetic eye drops and use of Nd:YAG laser 15 pulses (range 4-7 mJ/pulse).
The posterior hyaloids broke and immediately drained blood into the vitreous cavity.
We opted for an expectant attitude in his left eye (LE).
The VA one year after several reviews with significant improvement was 0.6 in the RE and 0.1 in the LE.
OCT revealed a premacular epiretinal membrane of recent onset in its left eye.
Nystagmus frequency decreased and amplitude became mild.
The bilateral hemovitreous remained slowly and progressively reabsorbed.
The patient refused any ocular surgery and was satisfied with the visual result achieved.
