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Christopher Roy Stelton, G Baker Hubbard; The Natural History of Pre-macular Hemorrhage in Infants. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6056.
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In infants, the management of a very specific pattern of hemorrhage confined to the sub-internal limiting membrane or sub-hyaloid spaces after traumatic shaking injury has not been extensively studied and no consensus among pediatric vitreoretinal surgeons exists as to the optimal timing for surgical intervention. This situation may be difficult for the pediatric vitreoretinal surgeon and the literature offers little guidance. We describe the typical presenting features, management, and visual outcomes of infants after non-accidental trauma with pre-macular hemorrhage. We performed a retrospective, observational case review.<br />
Eligible patients were identified by a computerized search of the Emory Eye Center database. Children with a specific pattern of blood confined to the sub-internal limiting membrane or sub-hyaloid spaces obscuring the macula were included. Relevant information was recorded, including age at time of bleed, visual function, anatomic findings, and associated neurologic history. A total of 22 patients and 36 eyes over a period greater than 12 years were identified. Our main outcome measures were mean time to resolution of blood and other ocular co-morbidities.
30/36 (83.3%) eyes underwent observation. 6/36 (16.7%) eyes had surgical intervention. There was no worsening of visual function documented as compared with presenting vision in the 12 patients who had visual acuity noted at initial consultation and at follow up. 5/12 eyes (41.7%) had improvement in visual function. When observed, the mean time to resolution of the blood was 2.96 months. Once the blood cleared, children suffered lasting ocular co-morbidities (i.e. optic atrophy, separation of the internal limiting membrane, macular pigmentary changes or scar, and strabismus).
Most cases of pre-macular hemorrhage do not require surgical intervention. When pre-macular blood is present, it typically clears by 3 months. Visual prognosis is often limited by ocular co-morbidities. Pre-macular membranes are common. Some eyes may benefit from pars plana vitrectomy (i.e. large hemorrhages or eyes with significant membranes).<br />
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