Associated Retinal Consultants, Royal Oak, Michigan, USA.
Ophthalmology. 2010 Mar;117(3):561-6. doi: 10.1016/j.ophtha.2009.08.013. Epub 2009 Dec 24.
To present fluorescein angiographic findings demonstrating retinal vascular alterations in children subjected to nonaccidental trauma (NAT).
Retrospective non-comparative consecutive case series.
Ten eyes of 5 children with the diagnosis of NAT seen at William Beaumont Hospital between August 2007 and December 2008.
We retrospectively reviewed the charts of 5 consecutive patients with NAT. All patients underwent detailed ophthalmic evaluation under anesthesia, fundus photography, and fluorescein angiography (FA).
The primary outcome was FA findings demonstrating alterations in retinal vascular perfusion, retinal neovascularization, and traction retinal detachment.
Seven of 10 eyes demonstrated peripheral retinal nonperfusion by FA, with interruption of both the arterial- and venous-side of the retinal vascular tree. All of the eyes with retinal nonperfusion also presented with preretinal and/or vitreous hemorrhage; none of the eyes without ischemia demonstrated preretinal or vitreous blood. None of the children were born prematurely or had a medical or family history that could otherwise explain their findings. None of the eyes exhibited neovascularization or retinal detachment. Two eyes were treated with laser photocoagulation alone; 2 eyes were treated with vitrectomy alone owing to a nonclearing premacular hemorrhage; 2 eyes were treated with vitrectomy and laser photocoagulation; and 1 eye was observed without treatment.
Peripheral retinal nonperfusion was noted by FA in 7 eyes of infants who were victims of nonaccidental head trauma. Preretinal and/or vitreous hemorrhage may be associated with the development of retinal nonperfusion. Physicians may consider FA in children with known or suspected NAT. The role of prophylactic laser treatment is unclear, and close observation for the development of neovascularization is warranted.
展示非意外伤害性（NAT）儿童的荧光素眼底血管造影（FA）结果，以显示视网膜血管改变。
回顾性非对照连续病例系列。
2007 年 8 月至 2008 年 12 月在 William Beaumont 医院就诊的诊断为 NAT 的 5 例儿童的 10 只眼。
我们回顾性地分析了 5 例连续 NAT 患者的病历。所有患者均在全身麻醉下进行了详细的眼科评估、眼底照相和 FA。
主要观察指标是 FA 结果，显示视网膜血管灌注、视网膜新生血管和牵引性视网膜脱离的改变。
10 只眼中有 7 只通过 FA 显示周边视网膜无灌注，视网膜血管树的动脉侧和静脉侧均中断。所有出现视网膜无灌注的眼均伴有视网膜前和/或玻璃体积血；无缺血的眼均无视网膜前或玻璃体积血。这些儿童均非早产儿，也无其他可能解释其检查结果的医疗或家族史。无一只眼出现新生血管或视网膜脱离。2 只眼仅行激光光凝治疗；2 只眼因黄斑前出血未吸收而行玻璃体切除术；2 只眼行玻璃体切除术和激光光凝治疗；1 只眼未治疗。
在非意外伤害性头部创伤的婴儿的 7 只眼中，FA 观察到周边视网膜无灌注。视网膜前和/或玻璃体积血可能与视网膜无灌注的发生有关。对于已知或疑似 NAT 的儿童，医生可能会考虑进行 FA。预防性激光治疗的作用尚不清楚，需要密切观察是否发生新生血管。
