Binenbaum Gil, Chen Wendy, Huang Jiayan, Ying Gui-Shuang, Forbes Brian J
Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia; Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Division of Ophthalmology, Alpert Medical School at Brown University, Providence, Rhode Island.
J AAPOS. 2016 Apr;20(2):131-5. doi: 10.1016/j.jaapos.2015.12.008.
Ophthalmologists are commonly asked to interpret appearance of retinal hemorrhages (RH) in children with suspected traumatic head injury. We sought to determine the natural history of RH in young children with head trauma and to identify patterns suggestive of chronicity in order to help establish timing of suspected traumatic injury.
The medical records of children <2 years of age with abusive or accidental head trauma and RH on initial fundus examination who had 1 or more follow-up examination were retrospectively reviewed. Types of RH (intraretinal, preretinal) were noted; intraretinal hemorrhage (IRH) severity was graded as mild (0-10), moderate (10-20), or severe (>20, too numerous to count [TNTC]).
A total of 91 eyes of 52 children were studied. All eyes had IRH (62 eyes with TNTC). In all but one eye, IRH resolved to none or mild within 1-2 weeks. TNTC IRH did not persist beyond a few days. The longest an isolated IRH persisted was 32 days. Preretinal hemorrhage (PRH) was present in 68 eyes, persisting 5-111 days. On initial examination, 25% of eyes had only IRH, 75% both PRH and IRH; no eyes had only PRH. At 2 weeks, 3% had only IRH, 18% both, and 45% only PRH. In no eyes did RH worsen.
IRH clears rapidly, whereas PRH may persist for many weeks. The presence of TNTC IRHs indicates that trauma occurred within a few days prior to examination, whereas the presence of PRH with no or few IRHs suggests days to weeks since trauma. To accurately identify these patterns, eye examinations should be completed as soon as possible after admission, preferably within 24-48 hours.
眼科医生经常被要求解读疑似创伤性脑损伤儿童的视网膜出血（RH）表现。我们试图确定头部外伤幼儿RH的自然病程，并识别提示慢性病变的模式，以帮助确定疑似创伤性损伤的时间。
回顾性分析年龄小于2岁、因虐待性或意外性头部外伤初次眼底检查发现RH且进行了1次或更多次随访检查的儿童的病历。记录RH的类型（视网膜内、视网膜前）；视网膜内出血（IRH）严重程度分为轻度（0 - 10）、中度（10 - 20）或重度（>20，多得难以计数[TNTC]）。
共研究了52名儿童的91只眼。所有眼睛均有IRH（62只眼为TNTC）。除一只眼外，所有眼睛的IRH在1 - 2周内消退至无或轻度。TNTC的IRH不会持续超过几天。孤立的IRH持续时间最长为32天。68只眼存在视网膜前出血（PRH），持续5 - 111天。初次检查时，25%的眼睛仅有IRH，75%既有PRH又有IRH；没有眼睛仅有PRH。在2周时，3%的眼睛仅有IRH，18%既有PRH又有IRH，45%仅有PRH。没有眼睛的RH病情恶化。
IRH迅速清除，而PRH可能持续数周。TNTC的IRH表明在检查前几天内发生了创伤，而PRH且无或仅有少量IRH提示创伤后数天至数周。为准确识别这些模式，应在入院后尽快完成眼部检查，最好在24 - 48小时内。
