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Paola Yunue Jacobo Oceguera, Virgilio Morales-Canton, Samantha Salinas Longoria, Luvia Rodriguez Quiñones, Maria Ana Martinez-Castellanos; Retinal Hemorrhages in Pediatric Patients After Cardiopulmonary Resuscitation. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4476.
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Retinal hemorrhages are rarely found after cardiopulmonary resuscitation in pediatric patients with nontraumatic illnesses. The purpose is to report the presence of retinal hemorrhages in pediatric patients secondary to cardiopulmonary resuscitation in the absence of other risk factors as birth history or abusive head trauma.
Case series. We included eight eyes of four pediatric patients receiving chest compressions during resuscitative efforts of two different centers in Mexico. Clinical photographs and fluorescein angiography were obtained using wide-angle device. Additional information was obtained by handheld spectral domain optical coherence tomography (SD-OCT) in two patients.
All four patients survived to their resuscitative efforts and all of them had retinal hemorrhages. Of the eight eyes, six presented retinal hemorrhages. Four eyes of two patients showed pre- and intraretinal hemorrhages in the posterior pole, similar to those presented in shaken baby syndrome but in a less extension and severity. Two eyes of two patients only had a small number of pre- and intra retinal hemorrhages concentrated in the posterior pole. Angiography findings showed blocked fluorescence from hemorrhages, we did not find any additional pathology. The SD-OCT documented a preretinal hemorrhage, an internal sublimitant haemorrhage and a hemorrhagic retinoschisis. In one year follow up, the patient with the retinoschisis developed a macular scar, strabismus and low vision, and the patient with the sublimitant hemorrhage developed an atrofic area.
We emphasize the importance of the relation between retinal hemorrhages and cardiopulmonary resuscitation. Because of these findings we suggest the screening of every baby after receiving cardiopulmonary resuscitation maneuvers to rule out retinal damage. These findings in angiography and optical coherence tomography are not previously described. A larger number of patients should be evaluated in further studies to assess our findings.
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