Dense vitreous hemorrhages predict poor visual and neurological prognosis in infants with shaken baby syndrome
Dense vitreous hemorrhages predict poor visual and neurological prognosis in infants with shaken baby syndrome
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DOI：
10.3928/0191-3913-19960701-13
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发表时间：
1996-07-01
影响因子：
1.2
通讯作者：
Das, A
中科院分区：
文献类型：
--
作者：
Matthews, GP;Das, A
目的：探讨摇晃婴儿综合征患儿玻璃体出血的严重程度与神经损伤程度的关系及早期玻璃体切除的结果。方法：对5例确诊为虐待儿童的婴幼儿进行眼科检查和神经学检查，以确定不同程度的玻璃体视网膜改变和神经功能障碍。结果：3例双眼密集玻璃体出血合并多发性蛛网膜下腔出血合并脑挫伤患儿术后眼部及神经功能状况较差，包括光感(LP)或无光感(NLP)，视网膜裂孔或裂孔较大，视网膜缺血，严重脑病。另外两名婴儿表现为双侧玻璃体下和视网膜出血，无密集玻璃体受累，伴有轻度蛛网膜下腔出血和轻微的神经学表现，玻璃体切除术后，这些婴儿的视力改善到或保持在固定和跟随状态，两名婴儿的神经学都有所改善。结论：合并密集玻璃体出血的摇晃婴儿综合征患儿的视力预后较差，这是因为经常伴有明显的视网膜和视觉皮质病变，相比之下，仅有视网膜内或玻璃体下出血的婴儿预后较好，眼内和颅内结构的破坏较小。
Objective: A retrospective study was performed to examine the relationship between the severity of vitreous hemorrhages and the severity of neurological injury in infants with shaken baby syndrome, and the result of early vitrectomy in these infants, Methods: Five infants, ages 3 to 8 months, with confirmed child abuse underwent ocular examination and neurological testing to identify varying degrees of vitreoretinal changes and neurological dysfunction. Pars plana vitrectomy was performed on one or both eyes in each infant to remove the vitreous hemorrhage.Results: The three infants with bilateral dense vitreous hemorrhage and multiple subarachnoid hemorrhage and cerebral contusions had poor postoperative ocular and neurological outcomes including light perception (LP) or no light perception (NLP) vision, large retinal holes or tears, retinal ischemia, and severe encephalopathy. The other two infants presented with bilateral subhyaloid and retinal hemorrhages without dense vitreous involvement, along with mild subarachnoid hemorrhage and minimal neurological findings, Following vitrectomy, visual acuities in these infants improved to or remained at the fix and follow state, and both infants improved neurologically. Conclusions: The presence of dense vitreous hemorrhage in infants with shaken baby syndrome has a poor visual prognosis, due to the frequent concomitant occurrence of significant retinal and visual cortical pathology, In contrast, infants with only intraretinal or subhyaloid hemorrhage tend to have a much better prognosis, with less disruption of both intraocular and intracranial structures.