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Brett Bielory, Audina M. Berrocal, Sander R. Dubovy, Lisa C. Olmos, Ditte Hess; Digital Imaging Findings of Peripheral Retinal Hypoperfusion(PRH) in Shaken Baby Syndrome (SBS): A Case Series. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1051.
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The triad of SBS classically consists of retinal hemorrhages, long bone fractures, and subural hematomas that occur in the context of inconsistent history and commonly accompanied by other inflicted injures. Multi-layered intraretinal hemorrhages extending to the ora serrata (OS) are seen in 2/3 SBS victims. PRH, a late sequelae to non-accidental injuries (NAI), has been described (Goldenberg DT, Dresner KA, Trese MT, et al. Ophthalmology. 2010 Mar;117(3):561-6.), however bilateral PRH has never been reported. The purpose of this study is to determine and describe bilateral ischemic findings by fluorescein angiogram (FA) in SBS.
Computer generated search via Ophthalmic Imaging SytemsTM (Sacramento, CA)(OIS) retrieved RetCam2TM(Clarity Medical Systems, Pleasanton, CA) FA images of four previously shaken babies 2 - 6 months after trauma.
FA examinations revealed PRH (n=4; 1 male, 3 females). Bilateral PRH was seen in all subjects as depicted by a significant attenuated retinal vasculature and mottled retinal pigment epithelium. ERG showed marked depression in cones and rod response in one subject (n=1/4).
SBS is associated with peripheral hypoperfusion. Vascular Endothelial Growth Factor (VEGF), Pigment epithelium-derived factor (PEDF) families and signaling pathways are important in the retinal vascular development and perhaps play a role in downregulation of vascular development in SBS subjects. Use of diagnostic imaging sheds light on the possibility of a more intricate anti-angiogenic response in children subjected to numerous episodes of NAI. Histopathologic correlation recommended for further investigation.
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