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MARYO KOHEN, Faruk Orge; Preliminary Optical Coherence Tomography Findings in Abusive Head Trauma (Shaken Baby Syndrome). Invest. Ophthalmol. Vis. Sci. 2018;59(9):6180. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Controversy exists regarding making the diagnosis of abusive head trauma (AHT) despite having all the necessary resources such as magnetic resonance imaging, because several conditions have to be ruled out such as retinopathy of prematurity, sudden infant death syndrome and bleeding disorders. Unfortunately, there is no objective finding to definitively diagnose AHT. We performed an observational clinical study to test if optical coherence tomography (OCT) imaging in AHT can provide us a diagnostic finding to differentiate AHT from other look-alike conditions.We are proposing to use OCT to image retina and optic disc and find an objective finding that correlates with AHT. We hypothesize that with the use of OCT we will be able to diagnose moderate cases more precisely leading to better and faster treatment options for visual impairment.
Three consecutive patients with presumed AHT underwent complete ocular examination, fundus photography with the RetCam (Clarity Medical Systems, Pleasanton, CA) and imaging with the hand held spectral domain (SD) OCT Optovue model with the I-Stand.(Optovue, Fremont, CA).
All three patients had clinical findings consistent with AHT including preretinal and intraretinal hemorrhages. SD OCT documented disruption of the foveal architecture in two eyes, macular hole in two eyes and perimacular folds in two eyes. Intraretinal hemorrhages were documented in all six eyes by SD OCT.
The advanced cases of AHT are not hard to diagnose but unfortunately ends with death. The moderate cases stay alive but hard to diagnose. Undiagnosed cases usually live with potential visual problems for the rest of their lives. In our study we have encountered vitreoretinal abnormalities not detected on clinical examination such as small macular holes. We acknowledge that more data is needed for stronger correlation. However we believe our preliminary results supports the need to include OCT in the routine patient care in AHT. As more patients are enrolled the pathology correlated with AHT will help to better recognize undiagnosed cases which usually end up with potentially debilitating visual outcomes. We also hope by better diagnosing AHT we can punish care givers who get away because lack of evidence or prove innocence who are punished because of misinterpreting the findings.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Optical Coherence Tomography image of macular hole.
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