Pediatric Ophthalmology and Ocular Genetics, Wills Eye Institute, Suite 1210, 840 Walnut St, Philadelphia, PA 19107, USA.
Pediatrics. 2010 Nov;126(5):961-70. doi: 10.1542/peds.2010-1220. Epub 2010 Oct 4.
Retinal hemorrhage is a cardinal manifestation of abusive head trauma. Over the 30 years since the recognition of this association, multiple streams of research, including clinical, postmortem, animal, mechanical, and finite element studies, have created a robust understanding of the clinical features, diagnostic importance, differential diagnosis, and pathophysiology of this finding. The importance of describing the hemorrhages adequately is paramount in ensuring accurate and complete differential diagnosis. Challenges remain in developing models that adequately replicate the forces required to cause retinal hemorrhage in children. Although questions, such as the effect of increased intracranial pressure, hypoxia, and impact, are still raised (particularly in court), clinicians can confidently rely on a large and solid evidence base when assessing the implications of retinal hemorrhage in children with concern of possible child abuse.
视网膜出血是虐待性头部创伤的主要表现。自发现这种关联以来的 30 年中，包括临床、尸检、动物、机械和有限元研究在内的多个研究领域，已经对这种发现的临床特征、诊断重要性、鉴别诊断和病理生理学有了深入的了解。充分描述出血的重要性对于确保准确和完整的鉴别诊断至关重要。在开发能够充分模拟引起儿童视网膜出血所需的力的模型方面仍然存在挑战。尽管仍存在一些问题，如颅内压升高、缺氧和撞击的影响（特别是在法庭上），但临床医生在评估有虐待儿童嫌疑的儿童的视网膜出血的影响时，可以依靠大量可靠的证据基础。
