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Fluorescein angiographic and histopathologic findings of bilateral peripheral retinal nonperfusion in nonaccidental injury: a case series.

The triad of shaken baby syndrome consists of multilayered retinal hemorrhages, subdural hematomas, and neurologic abnormalities that often occur in the context of an inconsistent history and are commonly accompanied by other inflicted injures. Retinal hemorrhages are typically seen immediately after initial trauma. Unilateral peripheral retinal nonperfusion as a late sequela to non-accidental injuries (NAI) has recently been described. To our knowledge, bilateral 360° peripheral retinal nonperfusion has only been reported once in a single case, but we report the first case series of relevant clinicopathologic findings demonstrating bilateral peripheral retinal nonperfusion in 3 subjects with NAI. A computer-generated search of the Bascom Palmer Eye Institute patient database identified fluorescein angiographic (FA) images of 3 subjects with NAI more than 2 months after trauma. Florida Lions Eye Bank Ocular Pathology Laboratory case files from 2000 through 2010 were reviewed to obtain cases of children who had sustained NAI with ocular and systemic findings. Eleven full-term infants (21 eyes) 2 months to 8 years of age with confirmation of the cause and manner of death from the medical examiner’s office were included in the study. Five full-term unremarkable infants (10 eyes) with a clinical history of suspected epileptiform seizures, asphyxia, or drowning were considered control subjects in the study. Analysis of FA images of living subjects was correlated with the histologic features of control subjects and deceased subjects with NAI. Autopsy eyes had been previously evaluated histopathologically and were stained for hemoxylin and eosin, iron, and CD31 to characterize the peripheral retinal vasculature; stained for glial fibrillary acid protein to characterize glial proliferation; and stained for vascular endothelial growth factor (VEGF) receptor to evaluate the potential for peripheral neovascularization. The presence of vascular lumina and punctate (ie, presumed involuted blood vessels) endothelial staining throughout the retina was evaluated and compared with 5 cases of unremarkable, control infant eyes.