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+A 45-year-old woman was referred from the neurosurgery department for sudden bilateral loss of vision after ventriculoperitoneal bypass surgery for a temporal subdural hygroma and cranial occipital abscess. This was the result of a subacute post-surgical complication. A fortnight earlier she had undergone preventive spinal decompression surgery for Arnold-Chiari I malformation.
+The patient had a clinical history of 16 years, with mild headaches, unsteadiness, rotatory dizziness, self-limited vomiting of variable duration and mild vertical nystagmus for a year. The latter led to the suspicion and diagnosis of congenital malformation, as the rest of his symptoms were related to the ulcerative colitis he had been suffering from for years.
+Visual acuity (VA) at the first examination was hand movement in both eyes. Pupillary reactions were 2+ with no relative afferent pupillary defect. There was a high-frequency, medium-amplitude downward twitching nystagmus. Fundus examination showed bilateral retrohyaloid premacular and vitreous haemorrhage, confirmed by optical coherence tomography (OCT) and ocular ultrasound. All these findings were compatible with TS.
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+A posterior hyaloidectomy was performed in his right eye (OD) after instillation of anaesthetic eye drops and use of Nd:YAG laser 15 pulses (range 4-7 mJ/pulse) in the most inferior part of the haematoma. The posterior hyaloid ruptured and immediately drained blood into the vitreous cavity. A watchful waiting approach was chosen for his left eye (OI).
+The VA at one year, after several revisions with marked improvement, was 0.6 in the OD and 0.1 in the OI. OCT revealed a premacular epiretinal membrane of recent appearance in his OI. The frequency of nystagmus decreased and the amplitude became mild. Bilateral haemovitreal was still slowly and progressively resorbing.
+The patient refused any ocular surgery and was satisfied with the visual result achieved.
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+