Purpose To evaluate clinical fundus photographs and angiograms in a consecutive series of infants with non-accidental trauma. Features of retinal non-perfusion, neovascularization, and tractional retinal detachment were assessed. Treatment methods, visual and anatomic outcomes were recorded.
Methods Retrospective review of clinical notes, fundus photographs, and fluorescein angiograms of infants and children managed at two major children's referral centers between 1997 and 2004. Two enucleated eyes were also examined histologically.
Results Thirteen eyes of seven patients were found on clinical examination to have peripheral or total retinal non-perfusion with neovascularization. This was confirmed with fluorescein angiography in ten eyes of five patients.Vascular remodeling with arterio-venous anastamosis was noted. Five eyes of three patients evolved to massive proliferative retinopathy and late hemorrhage leading to complex tractional retinal detachments from 6 to 18 months after the original injury. The presence of non-perfusion did not correlate with severity of injury or extent and location of hemorrhage on initial presentation. Visual outcomes were poor in many patients, ranging from 2/200 to no light perception. Interestingly, a set of enucleated eyes from a patient expiring shortly after shaking injury exhibited no peri- or intravascular inflammation on histological examination. However, the peripheral vasculature appeared to be reduced in diameter.
Conclusion Peripheral or total retinal non-perfusion can be a sequela of non-accidental trauma in the shaken baby syndrome. Infants with this type of injury should have serial examinations and possibly fluorescein angiography as they may be susceptible to late vitreous hemorrhage and intractable retinal detachment. Further histological studies of eyes will prove to be invaluable in determining the mechanisms of non-perfusion in this syndrome.
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