Abstract
Abstract: :
Purpose: To describe the presentations, etiologies, outcomes and visual morbidity of children with vitreous hemorrhage. Methods: IRB approved retrospective case series. Thirty–six eyes of 32 pediatric patients with vitreous hemorrhage were reviewed. This series represents a random sample of patients under eighteen years of age who presented with vitreous hemorrhage to our institution over the past 8 years. Infants with vitreous hemorrhage secondary to retinopathy of prematurity were excluded. Results: The majority of vitreous hemorrhages occurred after blunt trauma (27.8%) and penetrating trauma (22.2%). Less frequent causes were pars planitis (8.3%), familial exudative vitreoretinopathy (5.6%), persistent hyperplastic primary vitreous (5.6%), shaken baby syndrome (5.6%), retinal astrocytoma (2.7%), Norries disease (2.7%), Eales disease (2.7%), and post–operative vitreous hemorrhage (2.7%). Decreased visual acuity (42%) and pupillary abnormalities (11%) were frequent presenting signs and symptoms. Several cases (16.7%) were noted during routine retinal exam following ruptured globe repair. Visual acuity ranged from 20/15 to no light perception on presentation and from 20/15 to no light perception on most recent follow up examination. Change in visual acuity ranged from 3 Snellen lines lost to 12 Snellen lines gained. Treatment modalities included observation, vitrectomy, laser, and cryotherapy. Observation alone was elected in 30.5% of patients. Vitrectomy was performed in 52.7% of cases and laser in 33.3% of cases. After penetrating trauma, vitrectomy and laser together were performed in 87.5% of cases. Cryotherapy was utilized in 13.8% of patients, being most frequently performed in pars planitis patients (100%). The greatest visual improvement occurred in pars planitis patients, who showed a mean visual improvement of 10 Snellen lines. Penetrating trauma patients were most likely to experience associated complications, such as retinal detachment, macular pucker and choroidal detachment. They also were the least likely to experience visual improvement, with a mean Snellen improvement of 2.1 lines gained. Conclusions: Vitreous hemorrhages in pediatric patients result from multiple different disease processes and mechanisms of injury. In our series, blunt and penetrating traumas were the most frequent causes. Penetrating trauma was least likely to be associated with a favorable visual outcome. Pars planitis was most likely to be associated with a good visual outcome: average final visual acuity was 20/20 with a mean of 10 Snellen lines of improvement.
Keywords: vitreous • clinical (human) or epidemiologic studies: outcomes/complications • retina