Korean J Ophthalmol.  2011 Oct;25(5):311-316. 10.3341/kjo.2011.25.5.311.

Retinal Hemorrhage Associated with Perinatal Distress in Newborns

• Choi YJ
• Jung MS
• Kim SY

• KMID: 1098632
• DOI: http://doi.org/10.3341/kjo.2011.25.5.311

Abstract

PURPOSE
To describe the ophthalmoscopic features and natural history in a case series of eyes that developed intraocular hemorrhages associated with perinatal distress and to evaluate their clinical courses.
METHODS
A retrospective chart review of 289 neonates with a medical history of perinatal distress was conducted. Among these 289 patients (578 eyes), 29 eyes of 17 neonates were found to have had retinal hemorrhages or vitreous hemorrhages (VH). A comprehensive chart review, including details of fundoscopic findings and perinatal history, was conducted.
RESULTS
Intraocular hemorrhage was present in 5.5% of the patients. Most hemorrhages (82.7%) were intraretinal. In our population, 17% (n = 5) of hemorrhages resolved within two weeks, but 31% (n = 9) did not resolve even after four weeks. Most hemorrhages spontaneously resolved without any specific sequelae; however, one infant's dense unilateral VH persisted up to three months after birth. When the patient was seen again at 3.5 years of age, she had developed axial myopia and severe amblyopia of the involved eye.
CONCLUSIONS
In asphyxiated newborns, the possibility of intraocular hemorrhages should be considered. Long-standing, dense hemorrhages obscuring the macula may lead to severe vision deprivation amblyopia. Therefore, ophthalmic examination should be considered in neonates with perinatal distress, and close observation is necessary for hemorrhages that do not resolve in this amblyogenic age group.

Keyword

Newborn infant; Perinatal distress; Retinal hemorrhage; Vitreous hemorrhage

MeSH Terms

Asphyxia Neonatorum/*complications
Female
Follow-Up Studies
Humans
Infant, Newborn
Male
Ophthalmoscopy
Retinal Hemorrhage/diagnosis/*etiology
Retrospective Studies
Time Factors
Visual Acuity
Vitrectomy

Figure

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  Fig. 1 Fundus photographs of retinal hemorrhages in neonates that had a history of birth asphyxia and amniotic fluid aspiration. (A) Participant 15, (B) participant 9.

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  Fig. 2 (A) B-scan ultrasonography of an infant with dense vitreous hemorrhage (participant 16). The infant had a persistent dense vitreous hemorrhage obscuring the macula of the left eye for up to three months. (B) Vitreous hemorrhages were absorbed completely after three months. (C) Fundus photographs of excyclotropia in the left eye at 3.5 years of age. The follow-up examination showed that the patient had developed myopia and severe amblyopia of the involved eye.

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