Ischemic retinopathy and neovascular proliferation secondary to shaken baby syndrome.
BACKGROUND
Ocular lesions known to occur after shaken baby syndrome (SBS) are epiretinal, intraretinal, and subretinal hemorrhages, which are present in up to 100% of patients. Retinoschisis and retinal folds have also been described. We describe three patients with SBS who presented with tractional retinal detachments secondary to neovascular proliferation and discuss the role of ischemia at the retinal level.


METHODS
Three patients (two 4-month-old babies and one 4-year-old child) with a history of SBS in the first year of life presented with tractional retinal detachment due to severe preretinal fibrovascular proliferation. Peripheral retinal ischemia and vascular disorganization were noted during clinical examination.


CONCLUSIONS
Although physiopathology of SBS remains disputed, ischemia has been accepted as the main feature of cerebral lesions. Ischemia could also be present at the retinal level as suggested by our patients' presentation. It could be induced by direct vitreous shearing of the capillary network or more probably by vascular leak due to brain edema and hypoxic damage of capillaries. Long-term ocular follow-up is necessary in SBS to treat these patients preventively.
Caputo
Georges
G
Department of Pediatric Ophthalmology, Fondation Ophtalmologique A. de Rothschildm, Paris, France. georgecaputo@mac.com
de Haller
Raoul
R
Metge
Florence
F
Dureau
Pascal
P
D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007511:Ischemia / Q000209:etiology*; D008297:Male; D009389:Neovascularization, Pathologic; D012163:Retinal Detachment / Q000209:etiology* / Q000601:surgery; D012171:Retinal Vessels / Q000473:pathology*; D038642:Shaken Baby Syndrome / Q000150:complications*