Optical Coherence Tomography and Visual Outcomes in Pediatric Abusive Head Trauma : Retinal Cases and Brief Reports

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Case Report

Optical Coherence Tomography and Visual Outcomes in Pediatric Abusive Head Trauma

Kelly, John P. PhD1,2; Feldman, Kenneth W. MD3,4; Weiss, Avery MD1,2

Author Information

1Roger H. Johnson Vision Clinic, Seattle Children’s Hospital, Division of Ophthalmology, Seattle, WA.

2University of Washington, Department of Ophthalmology

3Seattle Children’s Hospital, Safe Child and Adolescent Network

4University of Washington, Division of General Pediatrics

To whom correspondence should be sent: John P. Kelly, PhD, Roger H. Johnson Vision Clinic Seattle Children’s Hospital, OA.5.342, Seattle, WA, 98105 USA, Voice: 206-987-3899, email: [email protected]

Conflict of Interest: Dr. Feldman provides medical legal consultation in possible child abuse cases. John Kelly is an unpaid consultant to the University of Washington to maintain the quality control of Teller Acuity Cards, which were used in this study. Dr. Weiss has no potentially conflicting relationship.

Retinal Cases & Brief Reports ():10.1097/ICB.0000000000001353, September 16, 2022. | DOI: 10.1097/ICB.0000000000001353

Abstract

Purpose: 

Compare follow-up optical coherence tomography (OCT) with visual function in children with abusive head trauma (shaken baby syndrome).

Methods: 

Retrospective follow-up studies of 3 children who were victims of abusive head trauma (AHT) within the first year of life.

Results: 

OCTs showed disrupted retinal layering, thick detached internal limiting membrane, focal posterior vitreous separation, and multilayered tractional retinoschisis. Significant vision loss occurred in 3 out of 4 eyes with a history of traumatic retinoschisis. Normal visual acuity and low-normal visual evoked potentials were measured in a child with foveal distortion, reduced global nerve fiber layer thickness, detached internal limiting membrane, and history of vitreous hemorrhage.

Discussion: 

Significant abnormalities of retinal anatomy can be detected on OCT years after AHT. OCTs and assessment of visual pathways help to elucidate causes of visual dysfunction in children with AHT.

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