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Vitreoretinal traction may be important in development of retinoschisis due to shaken baby syndrome
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 Alex V. Levin |
PHILADELPHIA — The low incidence of skull fracture in infants with macular retinoschisis due to abusive head injury suggests that vitreous traction at the macula is key to the disease's pathogenesis, a presenter said here.
Of infants with shaken baby syndrome, 85% have retinal hemorrhages and one-third of these have retinoschisis, Alex V. Levin, MD, MHSc, said at the Wills Eye Institute Alumni Conference.
"Shaken baby syndrome, which is a form of abusive head trauma ... is a syndrome in which a perpetuator violently submits a child to repeated acceleration-deceleration forces with or without blunt head impact," he said.
Retinoschisis has only been reported in shaken baby syndrome, fatal head crush injuries and fatal motor vehicle accidents, according to Dr. Levin.
He and colleagues reviewed the medical records of 147 abused children, mean age 9.33 months, at Alberta Children's Hospital and the Hospital for Sick Children, Toronto.
Twenty-five percent had retinoschisis; of these, 60% were unilateral cases. Severe retinal hemorrhages occurred in 83% of patients, while 23% had skull fractures.
The study suggests that retinoschisis is associated with severe shaken baby syndrome and high rates of cerebral edema, papilledema and adverse neurologic and visual outcomes, the study authors said.
"I think all of this does support the ongoing theory ... that it is the vitreoretinal traction that actually causes the ocular pathology in [macular retinoschisis]," Dr. Levin said.
- Disclosure: No products or companies are mentioned that would require financial disclosure.
The familiar phone call from the PICU of your Children’s Hospital asks for a consult by the pediatric ophthalmologist to rule out retinal hemorrhages in a case of suspected nonaccidental trauma or shaken baby syndrome. Going through your mind is that when you find retinal hemorrhages on your examination, you have to determine from an ophthalmic standpoint whether this is indeed nonaccidental trauma. In Dr. Alex Levin’s report from the Wills Eye Institute Alumni Conference, he confirms the incidence of retinal hemorrhages of infants with shaken baby syndrome to be 85% but states that one-third of these babies have retinoschisis. He further states that since retinoschisis has only been reported in shaken baby syndrome, fatal head crush injuries and fatal motor vehicle accident that this finding definitively confirms the diagnosis of shaken baby syndrome. As we continue to see these tragic cases, and we are called to make definitive decisions and to testify in depositions or court cases, this information is added ammunition to our documentation of our ophthalmic findings.
– Robert S. Gold, MD
OSN
Pediatrics/Strabismus Section Editor
Disclosure: Dr. Gold reports no
relevant financial relationships.