Long-term Visual Sequelae of Shaken Baby Syndrome: A Retrospective Study of 52 Cases

To perform a clinical descriptive analysis of the long-term ophthalmological sequelae present in shaken baby syndrome and to evaluate a possible correlation between the grade of initial retinal hemorrhage at diagnosis and the severity of ophthalmological sequelae at school age and whether there was an association between the resorption time of initial retinal hemorrhages and ophthalmological sequelae.

Fifty-two children aged 5 to 11 years with retinal hemorrhages and confirmed shaking injury were included. Visual acuity, fundus, macular optical coherence tomography, retinal nerve fiber layer, and visual fields were evaluated and analyzed according to initial retinal hemorrhage severity.

In the study population, 50% of children had macular impairment seen on optical coherence tomography (epiretinal membrane, retinal atrophy, internal limiting detachment, or vitreous abnormality), 42.3% had amblyopia (18% functional amblyopia and 24% organic amblyopia), 42% had strabismus, 40% had fundus abnormality (scar visible on fundus or infrared), 37% had retinal nerve fiber layer deficiency, 8% had visual field impairment (chiasmatic or retrochiasmatic impairment), and 2% had cortical blindness. Children had significantly more ophthalmological sequelae if the retinal hemorrhages were grade 3 according to the 2011 Haute Autorité de Santé (HAS) classification (French classification of retinal hemorrhages based on their number and topography). The longer the retinal hemorrhage resorption time, the more significant the ophthalmological sequelae appeared to be.

Shaken baby syndrome is responsible for numerous ophthalmological sequelae. Some are irreversible (epiretinal membrane), whereas others are reversible and can be rehabilitated (amblyopia). Detecting ophthalmological sequelae is important to monitor for complications that may arise and also contributes to the child's integration into society.