DENSE VITREOUS HEMORRHAGES PREDICT POOR VISUAL AND NEUROLOGICAL PROGNOSIS IN INFANTS WITH SHAKEN BABY SYNDROME

Objective: A retrospective study was performed to examine the relation ship between the severity of vitreous hemorrhages and the severity of neurological injury in infants with shaken baby syndrome, and the resu lt of early vitrectomy in these infants, Methods: Five infants, ages 3 to 8 months, with confirmed child abuse underwent ocular examination and neurological testing to identify varying degrees of vitreoretinal changes and neurological dysfunction. Pars plana vitrectomy was perfor med on one or both eyes in each infant to remove the vitreous hemorrha ge. Results: The three infants with bilateral dense vitreous hemorrhag e and multiple subarachnoid hemorrhage and cerebral contusions had poo r postoperative ocular and neurological outcomes including light perce ption (LP) or no light perception (NLP) vision, large retinal holes or tears, retinal ischemia, and severe encephalopathy. The other two inf ants presented with bilateral subhyaloid and retinal hemorrhages witho ut dense vitreous involvement, along with mild subarachnoid hemorrhage and minimal neurological findings, Following vitrectomy, visual acuit ies in these infants improved to or remained at the fix and follow sta te, and both infants improved neurologically. Conclusions: The presenc e of dense vitreous hemorrhage in infants with shaken baby syndrome ha s a poor visual prognosis, due to the frequent concomitant occurrence of significant retinal and visual cortical pathology, In contrast, inf ants with only intraretinal or subhyaloid hemorrhage tend to have a mu ch better prognosis, with less disruption of both intraocular and intr acranial structures.