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PATHOLOGY OF PERIMACULAR FOLDS DUE TO VITREORETINAL TRACTION IN ABUSIVE HEAD TRAUMA
Waleed Abed Alnabi1, Garland J Tang2, Ralph C Eagle3
1Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania.
Insights
Vitreoretinal traction causes perimacular folds in abusive head trauma. Examination of children
Area of Science:
- Ophthalmology
- Pediatric Pathology
- Forensic Medicine
Background:
- Abusive head trauma (AHT) is a serious concern in pediatric forensic pathology.
- Perimacular folds are a recognized ocular finding in AHT, but their precise mechanism remains debated.
Observation:
- Gross and histopathologic examination of ten eyes from five pediatric AHT victims (2-13 months) was performed.
- Eyes were prepared to visualize the vitreoretinal interface, revealing vitreoretinal traction.
- Associated findings included intracranial injury, retinal hemorrhages, and optic nerve sheath hemorrhages.
Findings:
- Vitreoretinal traction was identified as the mechanism responsible for perimacular folds.
- Condensed vitreous attached to retinal fold apices and detached internal limiting membrane were observed.
- The findings support a biomechanical explanation for these specific retinal folds.
Implications:
- This study clarifies the pathogenesis of perimacular folds in AHT.
- Understanding this mechanism aids in the diagnosis and interpretation of ocular findings in suspected child abuse.
- The results contribute to the forensic evaluation of AHT cases.
Purpose:
To demonstrate vitreoretinal traction as a mechanism for perimacular folds in abusive head trauma.
Methods:
We performed gross and histopathologic examination of eyes of children with suspected abusive head trauma and identified those with typical perimacular folds. Information was collected regarding the incident that led to the child's death and systemic manifestations noted at autopsy. Eyes were prepared in a fashion that allowed for demonstration of the vitreoretinal interface.
Results:
Ten eyes of five patients (2-13 months) were examined. All patients had systemic manifestations of abusive trauma including intracranial injury. All cases provided evidence of vitreoretinal traction producing perimacular folds. Condensed vitreous was seen attached to the apices of the retinal folds, and the detached internal limiting membrane comprising the inner surfaces of the schisis cavity. Four cases showed severe bilateral multilayered symmetric retinal hemorrhages extending to the ora serrata. All cases showed optic nerve sheath subdural hemorrhage and subarachnoid hemorrhage. Orbital hemorrhage was unilateral in two cases and bilateral in three cases. Four cases showed orbital fat hemorrhage. One case showed extraocular muscle sheath and cranial nerve sheath hemorrhage. Two cases showed juxtapapillary intrascleral hemorrhage.
Conclusion:
Vitreoretinal traction is the likely mechanism of perimacular folds in abusive head trauma.
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