• Neurosurgery · Jan 2021

    Ocular Fundus Abnormalities in Acute Subarachnoid Hemorrhage: The FOTO-ICU Study.

    • Rahul A Sharma, Philip S Garza, Valérie Biousse, Owen B Samuels, Nancy J Newman, and Beau Benjamin Bruce.
    • Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
    • Neurosurgery. 2021 Jan 13; 88 (2): 278-284.

    BackgroundOcular fundus abnormalities, especially intraocular hemorrhage, may represent a clinically useful prognostic marker in patients with acute subarachnoid hemorrhage (SAH).ObjectiveTo evaluate associations between ocular fundus abnormalities and clinical outcomes in acute SAH.MethodsProspective evaluation of acute SAH patients with ocular fundus photography at bedside. Multivariable logistic models were used to evaluate associations between fundus abnormalities and poor outcome (inpatient death, care withdrawal, or discharge Glasgow Outcome Score <4) and intensive care unit (ICU) and hospital lengths-of-stay, controlling for APACHE II score, respiratory failure at ICU admission, Hunt & Hess score, aneurysmal etiology, age, and sex.ResultsFundus abnormalities were present in 29/79 patients with acute SAH (35.4%), and 20/79 (25.3%) had intraocular hemorrhage. In univariate analyses, poor outcomes were more likely among patients with fundus abnormalities vs without (15/28 [53.6%] vs 15/51 [29.4%], P = .03); median length of ICU stay was longer in patients with intraocular hemorrhage than without (18 d [interquartile range (IQR) 12-25] vs 11 [IQR 7-17], P = .03). Logistic regression with fundus abnormality as predictor of interest showed that male sex (odds ratio [OR] 5.33 [95% CI 1.09-26.0], P = .045), higher APACHE II (OR, per 1-point increase, 1.35 [95% CI 1.08-1.78], P = .01), and aneurysmal etiology (OR 4.35 [95% CI 1.01-22.9], P = .048), but not fundus abnormalities (OR 1.56 [95% CI 0.43-5.65], P = .49) or intraocular hemorrhage (OR 1.28 [95% CI 0.26-5.59], P = .75) were associated with poor outcome.ConclusionAlthough ocular fundus abnormalities are associated with disease severity in SAH, they do not add value to patients' acute management beyond other risk factors already in use.Copyright © 2020 by the Congress of Neurological Surgeons.

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