Department of Strabismus and Paediatrics, Moorfields Eye Hospital, London, UK.
Br J Ophthalmol. 2013 Sep;97(9):1138-42. doi: 10.1136/bjophthalmol-2012-302429. Epub 2013 May 4.
There are few high-quality studies describing the appearance and location of retinal haemorrhages in critically ill children not due to birth or abusive head trauma.
Prospective study from February 2008 to December 2009 of emergency admissions to a paediatric intensive care unit aged over 6 weeks. Children with a penetrating eye injury or suspected or proven abusive head injury were excluded. The children underwent either dilated funduscopy performed by a paediatric ophthalmologist or RetCam imaging.
Retinal haemorrhages were identified in 24/159 (15%) patients. 50% of the haemorrhages were bilateral. The severity was mild (<5 retinal haemorrhages) or moderate (5-20 retinal haemorrhages) in 75%. The location was in zone 1 in 45.8%, zones 1 and 2 in 33.3%, zone 2 alone in 8.3% and not described in 8.3%. Schisis cavities and perimacular folds were identified in two patients with one having a pseudohypopyon appearance; a further one patient had bilateral haemorrhagic retinal detachments. Three patients had exudates or scarring consistent with cytomegalovirus infection.
Retinal haemorrhages are seen in a proportion of critically ill children, however most retinal bleeding is not extensive as indicated by location within the retina or layer of bleeding. Higher numbers and extent of retinal haemorrhages were only observed in the presence of severe coagulopathy, leukaemia, one victim of a road traffic accident, and one child who sustained a fatal witnessed fall down the stairs; all circumstances that would be readily distinguished by history and laboratory testing from abusive head injury.
仅有少数高质量的研究描述了非因产伤或虐待性头部外伤而导致的危重症患儿视网膜出血的外观和位置。
2008 年 2 月至 2009 年 12 月，对儿科重症监护病房（PICU）收治的年龄超过 6 周的急症患儿进行前瞻性研究。排除穿透性眼部损伤或疑似或证实的虐待性头部外伤患儿。对这些患儿行由小儿眼科医生进行的散瞳眼底检查或行 RetCam 成像检查。
在 159 例患儿中，有 24 例（15%）患儿发现视网膜出血。50%的出血为双侧性。75%的患儿出血程度较轻（<5 个视网膜出血）或中度（5-20 个视网膜出血）。出血位置在 1 区者占 45.8%，在 1 区和 2 区者占 33.3%，仅在 2 区者占 8.3%，8.3%的患儿未描述出血位置。2 例患儿存在 Schisis 腔和黄斑旁皱褶，其中 1 例表现为假性前房积脓外观；另 1 例患儿存在双侧出血性视网膜脱离。3 例患儿存在与巨细胞病毒感染一致的渗出物或瘢痕。
在一定比例的危重症患儿中可见视网膜出血，但大多数视网膜出血并不广泛，这可通过出血位于视网膜内或出血层次来判断。只有在严重凝血功能障碍、白血病、1 例道路交通伤患儿和 1 例因目击从楼梯上摔下致死的患儿中才观察到较多数量和较广泛的视网膜出血；所有这些情况均易于通过病史和实验室检查与虐待性头部外伤相鉴别。
