Vitreous hemorrhage in children.

PURPOSE

To describe the presentations, etiologies, and visual outcomes of spontaneous and traumatic vitreous hemorrhage in children.

DESIGN

Retrospective case series of patients seen over 8 consecutive years.

PARTICIPANTS

One hundred sixty-eight patients (186 eyes), younger than 18 years, with vitreous hemorrhage not secondary to active retinopathy of prematurity (ROP).

METHODS

Charts were reviewed and data were compiled with special attention to demographic information, diagnosis, examination findings, visual acuity (VA) on presentation and last follow-up, treatment type, and length of follow-up.

MAIN OUTCOME MEASURES

Etiologies, presenting symptoms, initial and final VAs, and management modalities.

RESULTS

Among 168 patients (186 eyes), the most common presenting symptom was decreased VA in older patients and strabismus and nystagmus in younger patients. Seventy-three percent of cases occurred secondary to manifest and occult trauma, with blunt (29.6%) and penetrating (24.7%) trauma being most common. Twenty-seven percent of hemorrhages occurred spontaneously, with regressed ROP being most common. Of the cases, 90.5% were unilateral and 9.5% were bilateral. Shaken baby syndrome accounted for 50% of bilateral cases. The most common management modalities were observation (50.0%) and incisional surgery (45.7%), but frequency of management modality varied by etiology. Visual outcomes, which were limited by variable follow-up and nonstandardized acquisition, were poorest with penetrating trauma and best with regressed ROP. There was no statistical difference in severe vision loss between children older than 8 years and younger than 8.

CONCLUSIONS

Pediatric vitreous hemorrhage may have multiple etiologies, but manifest and occult trauma are most common. Regressed ROP is a common cause of spontaneous vitreous hemorrhage. A substantial proportion of patients with vitreous hemorrhage had severe vision loss, but outcomes were highly dependent on underlying etiology.