PDF(Pubmed)
Abstract：
We evaluated the distribution and types of retinal hemorrhages (RHs) and other damages in eyes with abusive head trauma (AHT). This retrospective, consecutive case series of AHT and non-AHT conditions involved 54 children with AHT, 43 children with head bruises, and 49 children with blunt eye trauma, each of non-AHT supported by reliable witness accounts. RHs and other damage were evaluated using ophthalmoscopy and wide-field fundus photography. A variety of RH types and other damage were identified in the AHT group but not in the non-AHT group. RHs in AHT extended from the posterior pole to the far periphery in 77% of eyes and on/near the veins in 86% and arteries in 85%, most of which were in the far periphery. Retinoschisis, white-dot lesions, and retinal folds were seen even in the far periphery. RHs on/near the veins and arteries, retinoschisis, and retinal folds suggest a traumatic mechanism of the tractional force of the vitreous that is attached to the entire retinal surface. Identifying the distribution and arterio and venous origins of RHs is a key factor in determining the association with trauma. Thus, wide-field fundus photography is useful to record and evaluate the origin of the RHs and other retinal damage.
摘要：
我们评估了患有虐待性头部创伤（AHT）的眼睛中视网膜出血（RH）和其他损害的分布和类型。这次回顾，AHT和非AHT疾病的连续病例系列涉及54名AHT儿童，43名头部瘀伤儿童，和49名患有钝性眼外伤的儿童，每个非AHT都有可靠的证人证词支持。使用检眼镜检查和宽视野眼底照相评估RHs和其他损伤。在AHT组中发现了多种RH类型和其他损害，但在非AHT组中未发现。AHT中的RHs在77％的眼睛中从后极延伸到远周边，在86％的静脉和85％的动脉上/附近，其中大部分都在遥远的外围。Retinoschisis,白点病变,甚至在远处也能看到视网膜褶皱。静脉和动脉上/附近的RH，视网膜分裂,和视网膜褶皱表明附着在整个视网膜表面的玻璃体牵引力的创伤性机制。确定RHs的分布以及动静脉起源是确定与创伤关联的关键因素。因此，宽视野眼底摄影可用于记录和评估RHs的起源和其他视网膜损伤。
