Early Pars Plana Vitrectomy and Anti-vascular Endothelial Growth Factor (VEGF) in the Management of Terson Syndrome: A Case Linked to Methicillin-Resistant Staphylococcus aureus (MRSA) Meningitis

We present a case of Terson syndrome, characterized by intraocular hemorrhage following acute intracranial events, which poses significant diagnostic and management challenges. The patient was a 45-year-old female with Terson syndrome associated with methicillin-resistant Staphylococcus aureus (MRSA) meningitis and ventriculitis. She presented with vision loss and was found to have sub-internal limiting membrane (sub-ILM) hemorrhages and dense vitreous hemorrhages. Early pars plana vitrectomy (PPV) in the left eye yielded substantial visual improvement. In contrast, delayed intervention in the right eye following anti-vascular endothelial growth factor (VEGF) therapy showed limited recovery. Systemic stabilization was achieved through targeted intravenous antibiotics. This report underscores the critical role of early surgical intervention and multidisciplinary management in optimizing visual and systemic outcomes in complex cases of Terson syndrome. The diagnostic significance of sub-ILM hemorrhage emphasizes its role as a specific marker of severe ocular involvement, necessitating prompt recognition and treatment.