Nonaccidental trauma and peripheral retinal nonperfusion

Abstract

Purpose: To present fluorescein angiographic findings demonstrating retinal vascular alterations in children subjected to nonaccidental trauma (NAT).

Design: Retrospective non-comparative consecutive case series.

Participants: Ten eyes of 5 children with the diagnosis of NAT seen at William Beaumont Hospital between August 2007 and December 2008.

Methods: We retrospectively reviewed the charts of 5 consecutive patients with NAT. All patients underwent detailed ophthalmic evaluation under anesthesia, fundus photography, and fluorescein angiography (FA).

Main outcome measures: The primary outcome was FA findings demonstrating alterations in retinal vascular perfusion, retinal neovascularization, and traction retinal detachment.

Results: Seven of 10 eyes demonstrated peripheral retinal nonperfusion by FA, with interruption of both the arterial- and venous-side of the retinal vascular tree. All of the eyes with retinal nonperfusion also presented with preretinal and/or vitreous hemorrhage; none of the eyes without ischemia demonstrated preretinal or vitreous blood. None of the children were born prematurely or had a medical or family history that could otherwise explain their findings. None of the eyes exhibited neovascularization or retinal detachment. Two eyes were treated with laser photocoagulation alone; 2 eyes were treated with vitrectomy alone owing to a nonclearing premacular hemorrhage; 2 eyes were treated with vitrectomy and laser photocoagulation; and 1 eye was observed without treatment.

Conclusions: Peripheral retinal nonperfusion was noted by FA in 7 eyes of infants who were victims of nonaccidental head trauma. Preretinal and/or vitreous hemorrhage may be associated with the development of retinal nonperfusion. Physicians may consider FA in children with known or suspected NAT. The role of prophylactic laser treatment is unclear, and close observation for the development of neovascularization is warranted.