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R. Hunter, C. D. Westerfeld, S. Mukai; Spontaneous Vitreous Hemorrhage in Children Without a History of Trauma, Ocular Procedure, or Prematurity. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4682.
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Spontaneous vitreous hemorrhage (VH) in children without a history of trauma, ocular procedure, or prematurity is rare. We reviewed the presentation, underlying diagnosis, treatment, and visual outcome of our pediatric cases of spontaneous VH.
Retrospective chart review of consecutive patients with spontaneous VH, 18 years of age or younger, who presented to the Retina Service at the Massachusetts Eye and Ear Infirmary between 1990 and 2008. Cases of VH secondary to trauma, ocular procedures, and prematurity were excluded. Seventeen eyes in 15 patients that met the criteria were identified.
The most common presenting symptom was decreased visual acuity. Eight (71%) testable patients had visual acuity of 20/400 or less on presentation. The average age of presentation was 7.2 years (0.1-16). Diagnoses included 5 (33%) cases of familial exudative vitreoretinopathy (FEVR), 4 (23%) of X-linked juvenile retinoschisis (XLRS), 2 (12%) each of pars planitis, incontinentia pigmenti , and nontraumatic rhegmatogenous retinal detachment, and 1 (6%) each of sickle cell retinopathy and retinoblastoma (RB). Two cases (13%) had bilateral VH. Pars plana vitrectomy was performed in 10 eyes (59%) and 1 case of RB was enucleated. Vision improved in 7 cases (70%) with average final visual acuity of 20/95 (20/30- 20/300). Eleven (65%) cases had no known diagnosis at presentation. In addition to clinical examination, ultrasound was necessary for diagnosis of 5 (46%) patients. Ancillary studies were needed for 2 (18%) additional patients and only 1 eye required surgical intervention for diagnosis.
Spontaneous VH is rare in children. The most common causes were FEVR and XLRS accounting for one third of cases. The etiology remained elusive after initial examination in 8 (73%) eyes. Prompt diagnosis is essential since amblyopia is a risk in this population. The majority of our patients showed visual improvement demonstrating the importance of early diagnosis, treatment, and close follow-up.
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