Kivlin J D, Simons K B, Lazoritz S, Ruttum M S
Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Ophthalmology. 2000 Jul;107(7):1246-54. doi: 10.1016/s0161-6420(00)00161-5.
To examine the comprehensive ophthalmologic experience with the shaken baby syndrome at one medical center, including clinical findings, autopsy findings, and the outcome of survivors.
Retrospective, noncomparative case series.
One hundred twenty-three children admitted from January 1987 through December 1998 for subdural hematomas of the brain secondary to abuse were included.
Clinical features of eye examinations of the patients during their admission and after discharge and histopathologic observations for patients who died were retrieved from medical records and statistically analyzed.
Visual response and pupillary response on initial examination, fundus findings, final vision, neurologic outcome of survivors, and death.
Ninety percent of the patients had ophthalmologic assessments. Retinal hemorrhages were detected in 83% of the examined children. The retinal hemorrhages were bilateral in 85% of affected children and varied in type and location. Nonophthalmologists missed the hemorrhages in 29% of affected patients. Poor visual response, poor pupillary response, and retinal hemorrhage correlated strongly with the demise of the child. One child who died had pigmented retinal scars from previous abuse, a condition not previously observed histopathologically to our knowledge. One fifth of the survivors had poor vision, largely the result of cerebral visual impairment. Severe neurologic impairment correlated highly with loss of vision.
Shaken baby syndrome causes devastating injury to the brain and thus to vision. Retinal hemorrhages are extremely common, but vision loss is most often the result of brain injury. The patient's visual reaction and pupillary response on presentation showed a high correlation with survival. Good initial visual reaction was highly correlated with good final vision and neurologic outcome. According to the literature, when retinal hemorrhages are found in young children, the likelihood that abuse occurred is very high. Nonophthalmologists' difficulty in detecting retinal hemorrhages may be an important limiting factor in identifying shaken babies so they can be protected from further abuse.
在一家医疗中心考察对摇晃婴儿综合征的综合眼科诊疗经验，包括临床发现、尸检结果及幸存者的预后情况。
回顾性、非对照病例系列研究。
纳入1987年1月至1998年12月因虐待继发脑硬膜下血肿而入院的123名儿童。
从病历中检索患者入院期间及出院后眼部检查的临床特征，以及死亡患者的组织病理学观察结果，并进行统计分析。
初次检查时的视觉反应和瞳孔反应、眼底检查结果、最终视力、幸存者的神经学预后及死亡情况。
90%的患者接受了眼科评估。在接受检查的儿童中，83%检测出视网膜出血。85%的患眼视网膜出血为双侧性，且类型和部位各异。非眼科医生漏诊了29%患眼的出血情况。视觉反应差、瞳孔反应差和视网膜出血与患儿死亡密切相关。一名死亡患儿有既往虐待所致的视网膜色素瘢痕，据我们所知，此前组织病理学上未观察到这种情况。五分之一的幸存者视力不佳，主要是脑性视力损害所致。严重神经功能障碍与视力丧失高度相关。
摇晃婴儿综合征会对大脑进而对视力造成毁灭性损伤。视网膜出血极为常见，但视力丧失大多是脑损伤的结果。患者就诊时的视觉反应和瞳孔反应与生存情况高度相关。良好的初始视觉反应与良好的最终视力及神经学预后高度相关。根据文献，幼儿发现视网膜出血时，发生虐待的可能性非常高。非眼科医生在检测视网膜出血方面存在困难，这可能是识别摇晃婴儿以便使其免受进一步虐待的一个重要限制因素。
