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Widespread retinal hemorrhages after retinopathy of prematurity screening with scleral depression
Anne K Jensen1, Brian J Forbes, Lorri B Wilson
1Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
Insights
Extensive intraretinal hemorrhages occurred in a premature infant with active retinopathy of prematurity (ROP) following scleral depression examination. This suggests careful use of scleral depression during ROP evaluations is crucial.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Medicine
Background:
- Retinopathy of prematurity (ROP) is a significant cause of vision impairment in premature infants.
- Scleral depression is a common examination technique used to assess peripheral retinal structures in ROP.
Observation:
- A case of extensive bilateral intraretinal hemorrhages is reported in a premature infant with active ROP.
- The hemorrhages occurred after an examination involving scleral depression.
Findings:
- This is the second reported case of examination-induced retinal hemorrhages.
- The previous case involved a different clinical presentation and patient history.
- Hypothesized pathogenesis involves ocular manipulation, intraocular pressure changes, and immature retinal vasculature.
Implications:
- Physicians should exercise caution and judiciously use scleral depression during ROP examinations.
- Awareness of this potential complication is important for managing premature infants with ROP.
- Examination-induced retinal hemorrhages have not been reported in the absence of active ROP.
Abstract:
We report a case of extensive bilateral intraretinal hemorrhages in a premature infant with active retinopathy of prematurity (ROP) after an examination with scleral depression. In the only other previously reported case, the retinal hemorrhages were limited to the posterior pole of an eye with preexisting vitreous hemorrhage, and the child had a history of severe necrotizing enterocolitis that required surgery. Investigators have hypothesized that the combination of ocular manipulation, abrupt intraocular pressure change, and fragile immature retinal vasculature with poor autoregulation may contribute to the pathogenesis of retinal hemorrhages. Physicians performing ROP examinations should be aware of this possibility and judiciously use scleral depression; however, examination-induced retinal hemorrhages in children have never been reported in the absence of active ROP.
