Intravitreal tPA and SF6 promote clearing of premacular subhyaloid hemorrhages in shaken and battered baby syndrome.
OBJECTIVE
Child abuse is a serious problem in many cultures. The ocular signs of shaken baby include intraretinal, subretinal, and preretinal hemorrhages. The hemorrhages may be unilateral or bilateral and are seen in 50% to 80% of patients. Previous treatment was limited to observation or vitrectomy, but some observed eyes develop amblyopia, and pediatric vitrectomy has many complications.


METHODS
We report 4 eyes in 2 children with shaken baby syndrome in whom we administered intravitreal tissue plasminogen activator (tPA) in an attempt to resolve preretinal hemorrhages earlier than observation alone without the complications of vitrectomy. The tPA dose ranged from 12.5-25 microg per injection. Eyes were injected once weekly for 3 consecutive weeks. Each time 0.25 cc of sulfur hexafluoride gas was also injected.


RESULTS
Within 1 week following the last tPA administration, complete resolution of the preretinal hemorrhage was seen. There were no associated ophthalmic complications.


CONCLUSIONS
Intravitreal tPA with an expansive gas is an alternative method to observation or vitrectomy for resolution of preretinal hemorrhages in battered babies and may allow faster resolution of hemorrhages without the complications of vitrectomy.
LSU Eye Center, Louisiana State University Medical Center School of Medicine, New Orleans 70112-2234, USA.
M D
MD
Conway
G A
GA
Peyman
M
M
Recasens
D001497:Battered Child Syndrome / Q000150:complications*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005654:Fundus Oculi; D006801:Humans; D007223:Infant; D007267:Injections; D008266:Macula Lutea; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use; D013459:Sulfur Hexafluoride / Q000627:therapeutic use*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014822:Vitreous Body; D014823:Vitreous Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator; D013459:Sulfur Hexafluoride