Vitreous hemorrhage in children

Abstract

Purpose: To describe the presentations, etiologies, and visual outcomes of spontaneous and traumatic vitreous hemorrhage in children.

Design: Retrospective case series of patients seen over 8 consecutive years.

Participants: One hundred sixty-eight patients (186 eyes), younger than 18 years, with vitreous hemorrhage not secondary to active retinopathy of prematurity (ROP).

Methods: Charts were reviewed and data were compiled with special attention to demographic information, diagnosis, examination findings, visual acuity (VA) on presentation and last follow-up, treatment type, and length of follow-up.

Main outcome measures: Etiologies, presenting symptoms, initial and final VAs, and management modalities.

Results: Among 168 patients (186 eyes), the most common presenting symptom was decreased VA in older patients and strabismus and nystagmus in younger patients. Seventy-three percent of cases occurred secondary to manifest and occult trauma, with blunt (29.6%) and penetrating (24.7%) trauma being most common. Twenty-seven percent of hemorrhages occurred spontaneously, with regressed ROP being most common. Of the cases, 90.5% were unilateral and 9.5% were bilateral. Shaken baby syndrome accounted for 50% of bilateral cases. The most common management modalities were observation (50.0%) and incisional surgery (45.7%), but frequency of management modality varied by etiology. Visual outcomes, which were limited by variable follow-up and nonstandardized acquisition, were poorest with penetrating trauma and best with regressed ROP. There was no statistical difference in severe vision loss between children older than 8 years and younger than 8.

Conclusions: Pediatric vitreous hemorrhage may have multiple etiologies, but manifest and occult trauma are most common. Regressed ROP is a common cause of spontaneous vitreous hemorrhage. A substantial proportion of patients with vitreous hemorrhage had severe vision loss, but outcomes were highly dependent on underlying etiology.