ABSTRACT
AIM: To report the retinal signs that distinguish abusive head trauma (AHT) from non-abusive head trauma (nAHT). METHODS: A systematic review of literature, 1950-2009, was conducted with standardised critical appraisal. Inclusion criteria were a strict confirmation of the aetiology, children aged <11 years and details of an examination conducted by an ophthalmologist. Post mortem data, organic disease of eye, and inadequate examinations were excluded. A multivariate logistic regression analysis was conducted to determine odds ratios (OR) and probabilities for AHT. RESULTS: Of the 62 included studies, 13 provided prevalence data (998 children, 504 AHT). Overall, retinal haemorrhages (RH) were found in 78% of AHT vs 5% of nAHT. In a child with head trauma and RH, the OR that this is AHT is 14.7 (95% confidence intervals 6.39, 33.62) and the probability of abuse is 91%. Where recorded, RH were bilateral in 83% of AHT compared with 8.3% in nAHT. RH were numerous in AHT, and few in nAHT located in the posterior pole, with only 10% extending to periphery. True prevalence of additional features, for example, retinal folds, could not be determined. CONCLUSIONS: Our systematic review confirms that although certain patterns of RH were far commoner in AHT, namely large numbers of RH in both the eyes, present in all layers of the retina, and extension into the periphery, there was no retinal sign that was unique to abusive injury. RH are rare in accidental trauma and, when present, are predominantly unilateral, few in number and in the posterior pole.
Subject(s)
Child Abuse/diagnosis , Craniocerebral Trauma/complications , Retinal Hemorrhage/etiology , Child , Child, Preschool , Diagnosis, Differential , Humans , Infant , Multivariate Analysis , Odds RatioABSTRACT
PURPOSE: To investigate infant tear film secretion and protein profile, and to compare major tear proteins, such as immunoglobulin A, lactoferrin, and lysozyme, with those of adult controls. METHODS: Tears were collected, with a cellulose rod, from 40 healthy infants (19 female infants and 21 male infants, gestational duration: 39.71 ± 1.27 weeks) within 48 hours of birth and 22 adults (10 female infants and 12 male infants, mean age: 24.95 ± 3.63 years). A second collection was obtained from 14 of the infants (8 female infants and 6 male infants, postnatal age: 7.76 ± 6.14 weeks). The tear volume was measured, and protein in the samples was analyzed by Bradford assay and gel electrophoresis. RESULTS: Median tear volume (interquartile range) was 0.5 µL (0.6-2 µL) for newborn infants, 2.5 µL (1.4-7.75 µL) for these infants at an older age, and 6 µL (2.73-12.75 µL) in adults (P < 0.001, Kruskall-Wallis test). Immunoglobulin A concentration was significantly lower in newborns (P < 0.001, analysis of variance). Lipocalin was present in 36% of the newborn tear samples, whereas serum albumin was found in 86%. Mean protein concentration (µg/µL ± SD) was 10.95 ± 5.51 in the newborns, 12.93 ± 3.99 in the older infants, and 13.04 ± 3.46 in the adults (P > 0.5, analysis of variance). CONCLUSIONS: This is the first study reporting an investigation of unstimulated infant tears, using a noninvasive collection method. Tear protein content demonstrated that the infant tear film is different to that in adults.
Subject(s)
Eye Proteins/analysis , Immunoglobulin A, Secretory/analysis , Lactoferrin/analysis , Muramidase/analysis , Tears/chemistry , Term Birth , Electrophoresis, Polyacrylamide Gel , Female , Gestational Age , Humans , Infant, Newborn , Male , Tears/metabolism , Young AdultABSTRACT
PURPOSE: To report an unusual case of serous retinal detachment at the macula in a patient with a history of sarcoidosis. METHOD: Case report. In a 44-year-old Caucasian man, the history, clinical features, fluorescein angiography, laboratory and radiological investigations, treatment, and lung autopsy findings are presented. RESULTS: A serous detachment of the retina in the macula of his left eye was observed. He had pulmonary hypertension secondary to active sarcoid granulomas that caused pulmonary angiitis. CONCLUSION: Serous retinal detachment at the macula may occur in association with pulmonary angiitis secondary to sarcoidosis.
Subject(s)
Macula Lutea/pathology , Retinal Detachment/etiology , Sarcoidosis, Pulmonary/complications , Adult , Fluorescein Angiography , Humans , Hypertension, Pulmonary/etiology , Lung/pathology , Macula Lutea/diagnostic imaging , Male , Retinal Detachment/diagnostic imaging , Sarcoidosis, Pulmonary/diagnosis , UltrasonographyABSTRACT
A prospective study of 30 glaucoma patients (one eye in each patient) treated by an ab externo holmium laser sclerostomy is presented. An average of 40.2 pulses with an energy of 100 mJ was necessary to produce a filtering bleb. The average pre-operative intraocular pressure was 25.5 +/- 7.4 mmHg, with an average of 14.06 +/- 5.7 mmHg post-operatively at the final follow-up. The mean follow-up was 7.5 months (range 5-12 months) and the mean age of the patients was 71.4 years. Using strict criteria 70% of sclerostomies were considered successful at the final follow-up visit. The main post-operative complication was iris plugging of the sclerostomy. This was dealt with successfully with a 'Q'-switched neodymium:YAG laser in 80% of cases. Our early experience with the laser suggests that it is an easy, quick method of producing a filtering bleb, and may be carried out as an office procedure. As the technique evolves its long-term success remains to be evaluated; however, it shows promise both as an alternative to trabeculectomy as a primary procedure and as an additional technique for more complicated cases of glaucoma.
