Pathology of Macular Retinoschisis Due to Vitreoretinal Traction in Abusive Head Trauma
Alex V. Levin, MD, MHSc; Waleed Abed Alnabi, MD; Garland J. Tang, MD; Avrey Thau, BS; Ralph C. Eagle, Jr, MD;
Sam Gulino, MD
Wills Eye Hospital
Philadelphia, Pennsylvania, USA
Introduction: Macular retinoschisis is seen in almost one-third of cases of abuse head trauma (AHT) during infancy or early childhood. The proposed mechanism is due to vitreoretinal traction. Evidence comes from studies using optical coherence tomography, but few studies present histopathologically confirmed vitreoretinal traction.
Methods: We performed gross and histopathologic examination of children with suspected AHT and identified those who demonstrated 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 demonstration of the vitreoretinal interface.
Results: Ten eyes of 5 patients, aged 2 to 13 months, were examined. All patients had systemic manifestations of abusive trauma and intracranial injury. All cases provided evidence of the 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 ora serrata. All cases showed optic nerve sheath subdural hemorrhage and subarachnoid hemorrhage. Orbital hemorrhage was unilateral in 2 cases and bilateral in 3 cases. Four cases showed orbital fat hemorrhage. One case showed extraocular muscle sheath and cranial nerve sheath hemorrhage. Two cases showed juxtapapillary intrascleral hemorrhage.
Discussion: These findings have critical forensic implication on mechanism of injury when perimacular folds and retinoschisis are seen clinically.
Conclusion: Postmortem examination can assist in identifying the mechanism of ocular findings and injury in AHT.
References: Levin, AV. Retinal Hemorrhage in Abusive Head Trauma. Pediatrics 2010;126:961-70