Thursday, 17 March 2011

SBS: Vitreoretinal traction may be important in development of retinoschisis due to shaken baby syndrome

Alex V. Levin, MD, MHSc
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.

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