Abstract
Purpose :
Abusive head trauma (AHT) can result in non-clearing vitreous hemorrhages (VHs), retinal detachments (RDs), and retinal tears that require vitreoretinal surgery. There is ample guidance from professional societies emphasizing the importance of urgent ophthalmologic evaluation after AHT, but there is no available literature evaluating the outcomes of vitreoretinal surgery in aggregate and providing guidance on the timing of vitreoretinal intervention in these patients. This case series combined with literature review aims to fill this knowledge gap.
Methods :
A case series of three patients from a large academic medical center were combined with cases obtained during a literature search for studies reporting outcomes of vitreoretinal surgery in children with AHT from 2011-2021. Nine studies were included. The visual acuity (VA) and anatomical outcomes were compared between patients who received vitreoretinal surgery within four weeks of diagnosis and those who had delayed surgery.
Results :
A total of 78 eyes from 57 patients received interventions ranging from panretinal photocoagulation to pars plana vitrectomy (PPV) and scleral buckling. Most required a PPV (74 eyes/95%). 72 eyes (92%) had a non-clearing VH, while 7 eyes (9%) had an RD. 75 eyes (96%) had anatomical success after surgery, defined as an attached retina without vitreous hemorrhage. Surgery performed within four weeks of injury showed a trend towards improved anatomical and VA outcomes as compared to delayed surgery.
Conclusions :
Vitreoretinal surgery after AHT has excellent anatomical success rates, but there is a trend towards improved VA outcomes when surgery is performed within four weeks of diagnosis. This highlights the importance of urgent ophthalmologic evaluation and referral to a pediatric retina specialist for non-clearing VH, RDs, and retinal tears after AHT.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.