Resolution patterns and duration of retinal haemorrhages measured by two-dimensional retinal area pixel counts from sequential retinal imaging in childhood encephalopathies: a morphometric study

Jones, Patricia A.; Minns, Robert A.; Tandon, Anamika; Fleck, Brian; Mulvihill, Alan

doi:10.1136/bmjophth-2019-000275

Cited by 2 publications

(5 citation statements)

References 13 publications

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“…Visual function assessments at follow-up were analyzed if there was sufficient recovery time to clear retinal hemorrhages [ 36 ]. For those with traumatic retinoschisis and vitreous hemorrhages, data were acceptable if the assessment was at least 65 days after presentation (days of recovery).…”

Section: Methodsmentioning

confidence: 99%

Pediatric abusive head trauma: visual outcomes, evoked potentials, diffusion tensor imaging, and relationships to retinal hemorrhages

et al. 2023

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Purpose Function and anatomy of the visual system were evaluated in children with abusive head trauma (AHT). The relationships between retinal hemorrhages at presentation were examined with outcome measures. Methods Retrospective review of data in children with AHT for 1) visual acuity at last follow-up, 2) visual evoked potentials (VEP) after recovery, 3) diffusion metrics of white matter tracts and grey matter within the occipital lobe on diffusion tensor imaging (DTI), and 4) patterns of retinal hemorrhages at presentation. Visual acuity was converted into logarithm of minimum angle of resolution (logMAR) after correction for age. VEPs were also scored by objective signal-to-noise ratio (SNR). Results Of 202 AHT victims reviewed, 45 met inclusion criteria. Median logMAR was reduced to 0.8 (approximately 20/125 Snellen equivalent), with 27% having no measurable vision. Thirty-two percent of subjects had no detectable VEP signal. VEPs were significantly reduced in subjects initially presenting with traumatic retinoschisis or hemorrhages involving the macula (p < 0.01). DTI tract volumes were decreased in AHT subjects compared to controls (p < 0.001). DTI metrics were most affected in AHT victims showing macular abnormalities on follow-up ocular examination. However, DTI metrics were not correlated with visual acuity or VEPS. There was large inter-subject variability within each grouping. Discussion Mechanisms causing traumatic retinoschisis, or traumatic abnormalities of the macula, are associated with significant long-term visual pathway dysfunction. AHT associated abnormalities of the macula, and visual cortical pathways were more fully captured by VEPs than visual acuity or DTI metrics.

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Section: Methodsmentioning

confidence: 99%

Pediatric abusive head trauma: visual outcomes, evoked potentials, diffusion tensor imaging, and relationships to retinal hemorrhages

et al. 2023

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“…The pattern B phenomenon was seen in all RH types and all aetiologies. Of all 429 haemorrhages, 94.7 per cent could be classified into one of the two described patterns A and B (Jones et al, 2019).…”

Section: The Natural History (Time To Resolution) Of Rhsmentioning

confidence: 99%

“…The Natural History (Time to Resolution) of RHs (Jones et al, 2019) The RetCam® imaging technique for this sub-study, on the time to resolution of RHs, was as previously described. When RHs were found, the intention was to perform daily imaging until all had resolved, but only while the patient was ventilated or anaesthetised.…”

Section: Relationship Between Ricp and Rhsmentioning

confidence: 99%

“…The objective of this study component was to determine the time to resolution, that is, the natural history of different-layered RHs, using RetCam®, and to describe the main patterns of their resolution in a group of children with encephalopathies (Jones et al, 2019). Few studies have attempted measured resolution of RHs (see Appendix S5 in the online Supporting Information).…”

Section: The Natural History (Time To Resolution) Of Rhsmentioning

confidence: 99%

“…The aim of this paper is to summarise our previous RH publications on the following constituent topicsa novel retinal zone classification (Fleck et al, 2010); a contemporary RH layer classification (Mulvihill et al, 2011); prediction of AHT from RHs (Minns et al, 2012); the relationship between raised intracranial pressure (RICP) and RHs (Minns et al, 2017a); and the natural history of RH (i.e. time to resolution) (Jones et al, 2019) which were a result of our seven-year research programme on RH, and to review our results in the light of other published empirical literature on RHs in children. This review paper is oriented primarily to the general paediatrician, but may assist the paediatric intensivist and child protection paediatrician.…”

Section: Introductionmentioning

confidence: 99%

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Retinal Haemorrhages in Childhood Encephalopathies: Review of a Prospective Research Programme

et al. 2021

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One important cause of retinal haemorrhages (RHs) in children is abusive head trauma (AHT). Our programme of research was conducted on children admitted to hospital over a seven-year period who had RHs as part of their clinical presentation. This paper summarises important findings from previous publications. As a prerequisite, two basic studies were necessary: (i) a method of reporting the precise location of the RH in the retina; and (ii) defining a simple clinical classification of RHs based on the appearance of the retinal layer involved. Because raised intracranial pressure (RICP) is a frequent secondary brain insult following serious adult head injury, causing hypoxic-ischaemic injury with a resultant poor outcome, it was considered whether such RICP might also cause RHs in children. Detailed, state-of-the-art monitoring methods were used to investigate this relationship along with retinal imaging. Methodical documentation of the type, area and lifespan of RHs meant that it was possible to address the question of predicting AHT from RH numbers and characteristics, and to describe not only the duration of different layer haemorrhages, but also a previously unreported observation that some RHs transiently enlarge over two to three days before resolving normally.

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Resolution patterns and duration of retinal haemorrhages measured by two-dimensional retinal area pixel counts from sequential retinal imaging in childhood encephalopathies: a morphometric study

Cited by 2 publications

References 13 publications

Pediatric abusive head trauma: visual outcomes, evoked potentials, diffusion tensor imaging, and relationships to retinal hemorrhages

Pediatric abusive head trauma: visual outcomes, evoked potentials, diffusion tensor imaging, and relationships to retinal hemorrhages

Retinal Haemorrhages in Childhood Encephalopathies: Review of a Prospective Research Programme

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