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J AAPOS. 2019 Oct 23. pii: S1091-8531(19)30507-5. doi: 10.1016/j.jaapos.2019.08.276. [Epub ahead of print]

Long-term visual outcomes following abusive head trauma with retinal hemorrhage.

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Department of Ophthalmology, University of Colorado Aurora. Electronic address:
University of Colorado School of Medicine, Aurora.
Department of Epidemiology, Colorado School of Public Health, Aurora.
Department of Ophthalmology, University of Colorado Aurora; Department of Ophthalmology, Children's Hospital Colorado, Aurora.



To report the rates of vision loss and select ocular findings after abusive head trauma (AHT) with retinal hemorrhages at a single center.


The study cohort was identified by review of billing records for patients presenting simultaneously with retinal hemorrhages and abusive head trauma at the Children's Hospital of Colorado from October 2005 to April 2017. The following data were analyzed: retinal examination at initial admission and visual acuity, other pertinent eye findings, and eye management at follow-up visits. Patients with <1 month of follow-up were excluded.


Of 96 children, at last follow-up 46% had abnormal vision for the given age in at least one eye. Ocular findings included strabismus (43%), amblyopia (40%), optic disk pallor (13%), and cortical visual impairment (19%). For the 41 patients with strabismus, 20 (49%) required eye muscle surgery. Cortical visual impairment was almost three times higher in patients with strabismus compared with patients without strabismus (P = 0.023) and almost 6 times higher in patients with optic disk pallor than in those without (P < 0.001). Three patients (3%) required retinal surgery.


In our study cohort, there was a high rate of long-term vision impairment and ophthalmologic comorbidities in children with AHT and retinal hemorrhage.

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