Widespread retinal hemorrhages after retinopathy of prematurity screening with scleral depression

Abstract

We report a case of extensive bilateral intraretinal hemorrhages in a premature infant with active retinopathy of prematurity (ROP) after an examination with scleral depression. In the only other previously reported case, the retinal hemorrhages were limited to the posterior pole of an eye with preexisting vitreous hemorrhage, and the child had a history of severe necrotizing enterocolitis that required surgery. Investigators have hypothesized that the combination of ocular manipulation, abrupt intraocular pressure change, and fragile immature retinal vasculature with poor autoregulation may contribute to the pathogenesis of retinal hemorrhages. Physicians performing ROP examinations should be aware of this possibility and judiciously use scleral depression; however, examination-induced retinal hemorrhages in children have never been reported in the absence of active ROP.

FIG 1

Bilateral, extensive, diffuse intraretinal hemorrhages 1 day following scleral depression. A, retinal periphery right eye; B, posterior pole right eye; C, posterior pole left eye; D, retinal periphery left eye. Stage 3 retinopathy of prematurity (D) and pre-plus disease (B, C) were present in both eyes as well.