Retinal and visual function in infants with non-accidental trauma and retinal hemorrhages
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ORIGINAL RESEARCH ARTICLE
Retinal and visual function in infants with non-accidental trauma and retinal hemorrhages John P. Kelly . Kenneth Feldman . Jason Wright . Sheila Ganti . James B. Metz . Avery Weiss
Received: 13 September 2019 / Accepted: 6 February 2020 Ó Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To investigate retinal function and visual outcomes in infants with retinal hemorrhages due to non-accidental trauma (NAT). Methods This is a retrospective review of full-field or multifocal electroretinogram (ERG) recordings, visual acuity in log minimum angle of resolution (logMAR), clinical status, and neuroimaging. Multifocal ERGs from the central 40° were compared to corresponding fundus imaging. Visual acuity was
measured by Teller cards at follow-up. ERGs were compared to controls recorded under anesthesia. Results Sixteen children met inclusion criteria (14 recorded during the acute phase and 2 during longterm follow-up). During the acute phase, ERGs (n = 4 full field; n = 10 multifocal ERG) showed abnormal amplitude, latency, or both in at least one eye. Ten subjects had significantly reduced responses in both eyes, 3 of which had an ERG dominated by a negative waveform (absent b-wave or P1). The remaining six
J. P. Kelly (&) Roger H. Johnson Vision Clinic, Seattle Children’s Hospital, Division of Ophthalmology, OA.5.342, Seattle, WA 98105, USA e-mail: [email protected]
S. Ganti Center for Clinical and Translational Research, Seattle Children’s Hospital, Seattle, USA
J. P. Kelly A. Weiss Department of Ophthalmology, University of Washington, Seattle, USA
J. B. Metz Department of Pediatrics, University of Vermont, Burlington, USA
K. Feldman Seattle Children’s Hospital, Children’s Protection Program, Seattle, USA K. Feldman Division of General Pediatrics, University of Washington, Seattle, USA J. Wright Division of Radiology, Seattle Children’s Hospital, Seattle, USA
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Doc Ophthalmol
subjects had responses in one eye that were near normal (C 50% of controls). ERGs were sometimes abnormal in local areas without hemorrhage. ERGs could be preserved in local areas adjacent to traumatic retinoschisis. Two subjects with reduced visual acuity had belated ERGs: One had an abnormal macular ERG and the other had a normal macular ERG implying cortical visual impairment. At follow-up, 10 of 14 subjects had significant visual acuity loss (C 0.7 agecorrected logMAR); four subjects had mild vision loss (B 0.5 age-corrected logMAR). Visual acuity outcome was not reliably associated with the fundus appearance in the acute phase. All subjects with a negative ERG waveform had severe vision loss on follow-up. Conclusions Retinal dysfunction was common during the acute phase of NAT. A near normal appearing fundus did not imply normal retinal function, and ERG abnormality did not always predict a poor visual acuity outcome. However, a negative ERG waveform was associated severe visual acuity loss. Potential artifacts
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