Treat retinal hemorrhage in shaken baby syndrome to prevent myopia development

WASHINGTON — If retinal hemorrhage persists longer than a month in infants with suspected shaken baby syndrome, it is prudent to perform vitrectomy, according to a speaker here.

“If the hemorrhages of babies under a year old do not clear for longer than a month, it is necessary to intervene with lens-sparing pars plana vitrectomy,” Brian J. Forbes, MD, told attendees of a workshop on shaken baby syndrome at the American Association for Pediatric Ophthalmology and Strabismus meeting. “Failure to do so may cause the infant to develop a high degree of myopia.”

The management of patients with shaken baby syndrome, or inflicted childhood neurotrauma, is an area of pediatric ophthalmology still in development, speakers at the workshop noted.

“This is not an easy diagnosis,” said Monte D. Mills, MD.

Retinal hemorrhage, a primary symptom of shaken baby syndrome, can also be seen in accidental trauma, retinopathy of prematurity, leukemia, hypertension, infectious retinitis and a number of other ocular disorders, Dr. Mills noted. Therefore it can be difficult for physicians to differentiate a child who had endured ocular trauma due to abuse from a child who developed similar symptoms due to other underlying causes.

“To diagnose the condition, surgeons need to know the history of the patient and work with the team of pediatricians, psychologists and law enforcement to reach a collective conclusion,” Dr. Mills said. “You can’t just look at a photo of the retina and know the ultimate cause of the hemorrhage.”

Retinal cameras and fundus imagers are helpful tools but are not definitive for diagnosis, said Alex V. Levin, MD.

“Photos are problematic in determining the cause [of the hemorrhage] because they don’t tell the whole story,” Dr. Levin said.

“It is important for surgeons to write detailed notes in their charts. Detail where the retinal hemorrhages lie and how many are present,” Dr. Levin added. Accurately detailing the characteristics and patterns of retinal hemorrhage in shaken baby syndrome may lead the physician to a better understanding of the phenomenon, he said.