Fluorescein Angiographic and Histopathologic Findings of Bilateral Peripheral Retinal Nonperfusion in Nonaccidental Injury: A Case Series

Bielory, Brett P.

doi:10.1001/archopthalmol.2011.1674

Cited by 12 publications

(6 citation statements)

References 12 publications

(6 reference statements)

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“…This series adds to the growing body of cases reported documenting bilateral retinal nonperfusion observed in pediatric patients with AHT 18 –20 and lends credit to the prevalence and reproducibility of these findings in AHT. While prior series have demonstrated retinal nonperfusion in the presence of retinal hemorrhages, the importance of this series is in demonstrating the persistence of these angiographic defects after other visible signs of trauma have resolved.…”

Section: Discussionsupporting

confidence: 57%

“…18,28,29 The biologic mechanism for these findings is unclear. Theories postulated include: vitreoretinal traction during violent shaking episodes may induce vascular damage and secondary nonperfusion in areas of tight vitreoretinal adhesion, 19 alteration of endothelial cell polarity may affect vascular endothelial growth factor distribution and signaling, 30 trauma-induced upregulation of endogenous angiostatic factors at the vitreous base may alter angiogenesis, 31,32 and trauma-related venous stasis may also explain the peripheral retinal ischemia observed. 20 While some authors have advocated the use of prophylactic laser treatment to areas of retinal ischemia, 18 in this series, only 2 of 5 patients were treated with laser, and further study is needed to guide the use of laser in these patients.…”

Section: Discussionmentioning

confidence: 99%

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The Use of Fluorescein Angiography to Evaluate Pediatric Abusive Head Trauma: An Observational Case Series

Tran

Read

et al. 2017

Journal of VitreoRetinal Diseases

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Background or Purpose: The evaluation of retinal hemorrhages in the setting of suspected abusive head trauma (AHT) has important medical, social, and legal implications. Challenges include late presentation after retinal hemorrhages have resolved and differentiating AHT-related retinal changes from mimicking pathologies. To date, angiographic evidence of peripheral retinal injury in AHT has been reported in small series, but further study is needed to determine the prevalence and long-term sequelae of these findings. The purpose of this study was to describe fluorescein angiography (FA) findings in pediatric patients with a history of definite AHT and demonstrate the potential utility of FA in evaluating cases of suspected abuse with late presentation. Methods: Retrospective case series of 10 eyes in 5 pediatric patients with a history of definite AHT. RetCam fundus photography images and digital FA were performed. Results: Peripheral retinal nonperfusion affected 10 of 10 eyes in patients with a history of definite AHT. These changes persisted after acute retinal hemorrhages had resolved. Conclusions: "Retinal surveys" using FA provide angiographic evidence of peripheral retinal nonperfusion that may be a sign of AHT. This series adds to the growing body of cases reporting similar AHT-related findings and additionally demonstrates the longevity of these pathologic changes after trauma, which has not been previously described. Fluorescein angiography may offer a distinct advantage in evaluating cases of suspected abuse with late presentation to medical care when pathognomonic retinal hemorrhages may no longer be present. Further study is needed to determine the prevalence and long-term sequelae of these findings.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

The Use of Fluorescein Angiography to Evaluate Pediatric Abusive Head Trauma: An Observational Case Series

Tran

Read

et al. 2017

Journal of VitreoRetinal Diseases

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“…Our group previously reported peripheral, but not macular, retinal nonperfusion in NAI using FA. 6 These changes included truncation of the vasculature and chorioretinal scarring temporal to the macula, which correlated with decreased CD31 vascular lumen markers in cadaver eyes. Some have suggested the presence of preretinal neovascularization as sequelae from NAI, although this has been contested in histopathologic correlations.…”

Section: Discussionmentioning

confidence: 90%

“…4,5 However, the presence of vascular nonperfusion in eyes with NAI has been limited to the peripheral retina using fluorescein angiography (FA) but has not been described in the more visually significant macula. 6 The current case documents OCT angiography (OCTA) findings of capillary nonperfusion in the macula in a patient with history of NAI.…”

Section: Introductionmentioning

confidence: 94%

Superficial and Deep Capillary Plexus Nonperfusion in Nonaccidental Injury on OCTA

Echegaray

Iyer

Acón

et al. 2022

Journal of VitreoRetinal Diseases

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Purpose: To report OCTA findings in a case of nonaccidental injury (NAI). Methods: Retrospective review of a clinical case. Results: A 5-year-old White child with a history of NAI at age 1 year presented with reduced vision in the left eye resulting from a closed funnel retinal detachment. The right eye had optic nerve pallor, peripheral vascular attenuation, and leakage. Optical coherence tomography angiography (OCTA) showed significant parafoveal attenuation of the superficial vascular plexus, intermediate capillary plexus, and deep capillary plexus. This correlated with inner and middle retinal layer thinning temporal to the fovea and preservation of the ellipsoid zone. The peripapillary vascular plexus was preserved. Laser photocoagulation was performed to the nonperfused peripheral retina, and intravitreal bevacizumab was injected. Attenuation of the superficial, intermediate, and deep capillary plexuses might represent chronic ischemic retinal changes from traumatic injury to the vitreoretinal interface and inner retina in NAI. Conclusions: OCTA identified nonperfusion of the superficial and deep vascular plexuses as late sequelae of NAI. Traumatic injuries to the vitreoretinal interface in NAI might lead to inner retinal ischemia and atrophy with vascular attenuation present on OCTA.

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“…6 Intravenous fluorescein angiography may detect characteristic areas of peripheral retinal nonperfusion, especially in the months after the incident. 7,8 These ancillary tests also have the potential to improve the understanding of pathophysiologic mechanisms of RHs and enable the ophthalmologist to identify retinal details not previously documented by clinical examination.…”

Section: The Eye Examinationmentioning

confidence: 99%

The Eye Examination in the Evaluation of Child Abuse

Christian

Levin

Flaherty³

et al. 2018

Pediatrics

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Child abuse can cause injury to any part of the eye. The most common manifestations are retinal hemorrhages (RHs) in infants and young children with abusive head trauma (AHT). Although RHs are an important indicator of possible AHT, they are also found in other conditions. Distinguishing the number, type, location, and pattern of RHs is important in evaluating a differential diagnosis. Eye trauma can be seen in cases of physical abuse or AHT and may prompt referral for ophthalmologic assessment. Physicians have a responsibility to consider abuse in the differential diagnosis of pediatric eye trauma. Identification and documentation of inflicted ocular trauma requires a thorough examination by an ophthalmologist, including indirect ophthalmoscopy, most optimally through a dilated pupil, especially for the evaluation of possible RHs. An eye examination is helpful in detecting abnormalities that can help identify a medical or traumatic etiology for previously well young children who experience unexpected and unexplained mental status changes with no obvious cause, children with head trauma that results in significant intracranial hemorrhage and brain injury, and children with unexplained death.

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Fluorescein Angiographic and Histopathologic Findings of Bilateral Peripheral Retinal Nonperfusion in Nonaccidental Injury: A Case Series

Cited by 12 publications

References 12 publications

The Use of Fluorescein Angiography to Evaluate Pediatric Abusive Head Trauma: An Observational Case Series

The Use of Fluorescein Angiography to Evaluate Pediatric Abusive Head Trauma: An Observational Case Series

Superficial and Deep Capillary Plexus Nonperfusion in Nonaccidental Injury on OCTA

The Eye Examination in the Evaluation of Child Abuse

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