Intravitreal tPA and SF6 promote clearing of premacular subhyaloid hemorrhages in shaken and battered baby syndrome.

摘要

BACKGROUND AND OBJECTIVE: Child abuse is a serious problem in many cultures. The ocular signs of shaken baby include intraretinal, subretinal, and preretinal hemorrhages. The hemorrhages may be unilateral or bilateral and are seen in 50% to 80% of patients. Previous treatment was limited to observation or vitrectomy, but some observed eyes develop amblyopia, and pediatric vitrectomy has many complications. PATIENTS: We report 4 eyes in 2 children with shaken baby syndrome in whom we administered intravitreal tissue plasminogen activator (tPA) in an attempt to resolve preretinal hemorrhages earlier than observation alone without the complications of vitrectomy. The tPA dose ranged from 12.5-25 microg per injection. Eyes were injected once weekly for 3 consecutive weeks. Each time 0.25 cc of sulfur hexafluoride gas was also injected. RESULTS: Within 1 week following the last tPA administration, complete resolution of the preretinal hemorrhage was seen. There were no associated ophthalmic complications. CONCLUSION: Intravitreal tPA with an expansive gas is an alternative method to observation or vitrectomy for resolution of preretinal hemorrhages in battered babies and may allow faster resolution of hemorrhages without the complications of vitrectomy.