Abstract
Purpose :
The visual consequences following retinal hemorrhage (RH) from abusive head trauma (AHT) can take years to manifest. We sought to characterize the long-term visual outcomes and prognostic factors in these children.
Methods :
Retrospective, multicenter cohort study at 3 hospitals of children with RH from AHT with one or more follow-up eye examinations. Primary outcomes were visual acuity, motility, and intraocular findings. Initial eye findings and non-ocular injuries were examined as predictive risk factors.
Results :
In total, 247 children were studied. RH severity at presentation was mild/moderate (25%), severe (56%), severe with retinoschisis or retinal folds (9%), and unspecified (10%). RH severity predicted final visual acuity (better-seeing eye), macular scar, macular atrophy, and optic atrophy (p<0.001). Initial visual acuity, optic atrophy, cerebral edema, and hypoxic-ischemic injury also predicted final visual acuity (p<0.001). At latest follow-up (mean 2.7 years, range 0.1-16.7 years), ocular findings included strabismus (32%); cortical visual impairment (24%); central visual impairment classified as mild/moderate (9%), severe/near-total/total (11%), unspecified (2%); optic atrophy (12%); macular scar (7%); nystagmus (5%); macular atrophy (3%). Of 5 children with normal vision who underwent macular optical coherence tomography, 3 had abnormal findings.
Conclusions :
Severity of RH and other presenting factors can provide predictive information about final visual outcomes in AHT. While visual impairment and strabismus are common in children with RH from AHT, long-term follow-up is often lacking. Permanent changes to the retina can occur without obviously impacting vision. Caregivers can be counseled and long-term clinical follow-up should be ensured to monitor for visual problems throughout childhood.
This is a 2020 ARVO Annual Meeting abstract.