Predictive value of non-ocular findings for retinal haemorrhage in children evaluated for non-accidental trauma

PURPOSE

To determine non-ocular examination findings in non-accidental trauma (NAT) patients that are associated with retinal haemorrhage and warrant urgent examination by an ophthalmologist.

METHODS

A hospital- and clinic-based retrospective cross-sectional and cohort study of children age 0-12 years who underwent workup for NAT over a span of nine years in a level I trauma and tertiary referral centre. Details of ocular and non-ocular examination and imaging findings at the time of NAT evaluation were collected by chart review. Univariate and logistic regression analysis for association between retinal haemorrhage and non-ocular examination findings was performed.

RESULTS

A total of 557 patients with ophthalmology evaluation and 425 without were included in this study. All ages combined, none of the cutaneous signs of trauma or non-skull fractures were associated with retinal haemorrhage on univariate analysis (p > 0.05). By logistic regression, subdural or extra-axial haemorrhage (OR = 16.2; 95% CI [5.11-51.3]), occipital lobe insult (OR = 6.2; 95% CI [1.77-21.6]) and Glasgow coma score (GCS) <15 (OR = 5.8; 95% CI [1.96-17.4]) were significant predictors of retinal haemorrhage.

CONCLUSION

Subdural or undistinguished extra-axial haemorrhage, GCS <15, and occipital lobe insult are risk factors for the presence of retinal haemorrhage in patients with suspected NAT and their presence warrant urgent dilated fundus examination by an ophthalmologist. The presence of cutaneous trauma or non-skull bone fractures without the aforementioned risk factors does not warrant ophthalmology evaluation.

Severe Inflammation and Hyphema After Micropulse Diode Transscleral Cyclophotocoagulation

PURPOSE

To describe vision-threatening complications after micropulse diode transscleral cyclophotocoagulation (MP-TSCPC).

METHODS

Retrospective case series. Medical charts of patients who underwent MP-TSCPC and developed visually significant inflammation and hyphema after the procedure were reviewed. Patients were seen at the Upstate Medical University Ophthalmology clinic between 2017 and 2019.

RESULTS

Out of 64 patients who underwent MP-TSCPC in the defined time period, 2 patients with postprocedure severe inflammation and hyphema were identified. One patient had severe-stage primary open-angle glaucoma (POAG). After MP-TSCPC, the patient was noted to have a large visually significant anterior chamber reaction and hyphema that occupied 80% of the anterior chamber on postprocedure day 1. The patient was treated with topical and oral corticosteroids, and topical atropine. The second patient had uncontrolled severe-stage POAG. The patient underwent MP-TSCPC. After the procedure, the patient was noted to have significant inflammation with fibrin and hyphema that filled 80% of the anterior chamber. The patient was treated with topical steroids.

CONCLUSIONS

As with any intervention, complications are inevitable. Recognition of complications and its possible associations allow for better and more individualized risk versus benefit analysis of an intervention. In this case series, exuberant anterior segment inflammation and hyphema occurred in 2 patients who underwent MP-TSCPC. The authors' goal is to raise awareness of severe anterior chamber inflammation and hyphema as complications occurring after laser treatment with a reputation of minimal or no side-effect profile and to better understand this relatively new laser advancement in the treatment of glaucoma.