PATHOLOGY OF PERIMACULAR FOLDS DUE TO VITREORETINAL TRACTION IN ABUSIVE HEAD TRAUMA. Issue 11 (November 2019)

• Record Type: Journal Article
• Authors: Abed Alnabi, Waleed; Tang, Garland J.; Eagle, Ralph C.; Gulino, Sam; Thau, Avrey; Levin, Alex V.
• Is Part Of: Retina. Volume 39:Issue 11(2019)
• Publication Date: 2019-11
• Subjects: abusive head trauma -- child abuse -- pathology -- perimacular folds -- retinoschisis -- shaken baby syndrome; Retina -- Diseases -- Periodicals; Retinal Diseases; Vitreous Body; 617.735
• DOI: 10.1097/IAE.0000000000002273
• Languages: English
• ISSNs: 0275-004X

Abstract

Abstract : Purpose: To demonstrate vitreoretinal traction as a mechanism for perimacular folds in abusive head trauma. Methods: We performed gross and histopathologic examination of eyes of children with suspected abusive head trauma and identified those with typical perimacular folds. Information was collected regarding the incident that led to the child's death and systemic manifestations noted at autopsy. Eyes were prepared in a fashion that allowed for demonstration of the vitreoretinal interface. Results: Ten eyes of five patients (2–13 months) were examined. All patients had systemic manifestations of abusive trauma including intracranial injury. All cases provided evidence of vitreoretinal traction producing perimacular folds. Condensed vitreous was seen attached to the apices of the retinal folds, and the detached internal limiting membrane comprising the inner surfaces of the schisis cavity. Four cases showed severe bilateral multilayered symmetric retinal hemorrhages extending to the ora serrata. All cases showed optic nerve sheath subdural hemorrhage and subarachnoid hemorrhage. Orbital hemorrhage was unilateral in two cases and bilateral in three cases. Four cases showed orbital fat hemorrhage. One case showed extraocular muscle sheath and cranial nerve sheath hemorrhage. Two cases showed juxtapapillary intrascleral hemorrhage. Conclusion: Vitreoretinal traction is the likely mechanism of perimacular folds in abusive head trauma. Abstract : Gross and histopathologic examination was performed on eyes of patients with suspected abusive head trauma who demonstrated typical perimacular folds. The results suggest vitreoretinal traction as the mechanism. These findings have critical forensic implication when perimacular folds and retinoschisis are seen clinically.