Retinal hemorrhage after pediatric neurosurgical procedures.
Publication/Presentation Date
4-1-2022
Abstract
BACKGROUND: Neurosurgical procedures may occur prior to eye examination in children with suspected abusive head trauma and raise questions by child abuse physicians and ophthalmologists regarding the contribution of neurosurgery to retinal hemorrhage found postoperatively. The purpose of this study was to determine the prevalence and patterns of retinal hemorrhage attributable to neurosurgical intervention in children.
METHODS: We conducted a retrospective cohort study of children undergoing neurosurgery who had postoperative ophthalmoscopy. Some children were also examined preoperatively. Primary outcome measures were the prevalence and patterns of retinal hemorrhage attributable to neurosurgical intervention. Medical records were reviewed to identify confounding coexistent diseases.
RESULTS: Among 267 children undergoing 289 neurosurgical procedures, there were no cases in which children had post-procedural retinal hemorrhage that could be attributed to neurosurgery. Retinal hemorrhage was seen in 32 (12%) cases, but in every case they were either already present on preoperative examination (13 cases) or matched the pattern of a coexistent known cause of retinal hemorrhage, including head trauma with unambiguous history and/or nonocular signs (13), hydrocephalus-related increased intracranial pressure with papilledema-associated peripapillary retinal hemorrhage (5), and retinopathy of prematurity ridge-associated retinal hemorrhage (1). No retinal hemorrhage could be attributed only to neurosurgery.
CONCLUSIONS: Although children undergoing child abuse evaluations may have intracranial hemorrhage requiring neurosurgery that occurs before a dilated retinal examination can be performed, our data suggest that neurosurgery independently is unlikely to produce retinal hemorrhage and therefore is not a significant confounding factor in the interpretation of retinal hemorrhage patterns in child abuse evaluations.
Volume
26
Issue
2
First Page
1
Last Page
74
ISSN
1528-3933
Published In/Presented At
Chung, C. W., Levin, A. V., Forbes, B. J., & Binenbaum, G. (2022). Retinal hemorrhage after pediatric neurosurgical procedures. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 26(2), 74.e1–74.e5. https://doi.org/10.1016/j.jaapos.2021.11.010
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
35304320
Department(s)
Department of Pediatrics
Document Type
Article