September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Systemic Associations of Macular Retinoschisis, Hemorrhagic Cysts, and Retinal Folds in Children.
Author Affiliations & Notes
  • Ijeoma Chinwuba
    Pediatric Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Cindy W. Christian
    Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Brian J. Forbes
    Pediatric Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Gil Binenbaum
    Pediatric Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Ijeoma Chinwuba, None; Cindy Christian, Dr. Christian provides medical-legal expert work in child abuse cases (R); Brian Forbes, None; Gil Binenbaum, None
  • Footnotes
    Support  NIH K12 EY015398 and NIH L30 EY018451-03.
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6389. doi:
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      Ijeoma Chinwuba, Cindy W. Christian, Brian J. Forbes, Gil Binenbaum; Systemic Associations of Macular Retinoschisis, Hemorrhagic Cysts, and Retinal Folds in Children.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6389.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : In children with suspected traumatic intracranial hemorrhage (ICH), retinal hemorrhage (RH) severity is associated with likelihood of abusive injury. Macular findings of retinoschisis (RS), hemorrhagic cysts (HC), and retinal folds (RF) are thought to be highly indicative of abusive injury. We sought to describe the etiologies, mechanisms, and systemic associations of these specific macular findings in children.

Methods : Retrospective case series from 2001 to 2009 of children <2 years of age evaluated for head trauma, and diagnosed with macular RS, HC, or RF. Outcomes included reported histories, physical exam, radiographic, laboratory, and child protective team findings.

Results : Of 531 medical records, 18 children met inclusion criteria (mean age 7.5 months (range 1.9-21)). Of 35 evaluable eyes, 22 had RS, of which 16 had HC; 10 had RF; and 6 had both RF and RS with or without HC. Every eye with macular finding had too-numerous-to-count, multilayered RH. All 18 children had neuroimaging showing acute subdural ICH; 11 had evidence of hypoxic/ischemic injury, 8 cerebral edema/mass effect, 7 subarachnoid ICH, 5 intraparenchymal ICH, 2 cervical spine injury. Fourteen (78%) had additional evidence of trauma, including fractures (12), bruises, abrasions and skin lacerations. Eight of 18 had signs of blunt head impact; of 10/18 without such signs, 6 had other body trauma, and 2 had caregivers confess to shaking. Four of 18 had only acute ICH, severe RH, and macular findings; 1 case involved confessed shaking; in the other 3 cases, a non-traumatic etiology could not be identified despite thorough clinical investigation. All 18 cases were diagnosed as trauma: 17 abusive and 1 accidental (an unambiguous crush head injury from a television).

Conclusions : Macular RS, HC, and RF in children are associated with significant traumatic head injury. All cases were accompanied by severe RH and acute ICH. The overwhelming majority had other signs of trauma, either abusive or unambiguous severe accidental head crush injury. While other causes exist for less severe retinal and intracranial findings, only severe trauma has been reported for these macular findings. Ten cases lacked clinical evidence of head impact; in 2 of these cases, caregivers confessed to shaking, suggesting shaking alone may produce these injuries.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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