Objective To observe the fundus characteristics and associated factors of retinal hemorrhage (RH) in newborns. Methods A total of 293 healthy newborns (586 eyes) were enrolled in this study. A digital wide-angle retinal imaging device (RetCam Ⅲ) was used to examine the subjects at about 2 days after birth (2.7plusmn;0.9) days. The images of posterior pole, temporal quadrant, superior quadrant, nasal quadrant and inferior quadrant of the fundus of each eye were taken sequentially. Every newborn completed the examination and the mean duration of the procedure was (2.62plusmn;0.55) minutes. Newborns with RH were reexamined after one month. RH was classified according to the location and size of the hemorrhages based on guidelines in the literature. The location and degree of RH was determined in each newborn. The incidence of RH by gender, parity, birth weight, maternal age and delivery method was compared and analyzed. Results RH was present in 87 eyes (14.8%) of 58 newborns (19.8%) and of the 58 newborns with RH, half (29 eyes) had hemorrhages in both eyes, and half (29 eyes) had hemorrhages in only one eye. The site of the hemorrhage was all on the superficial retina. Of the 87 eyes with RH, 72 eyes (82.8%) had hemorrhage in zone Ⅰ, 86 eyes (98.9%) had hemorrhage in zone Ⅱ, and 36 eyes (41.4%) had hemorrhage in zone Ⅲ. Thirty-eight eyes (43.7%) had hemorrhage in zone Ⅰand Ⅱ. Three eyes (3.4%) had hemorrhage in zone Ⅱ and Ⅲ. Thirtythree eyes (37.9%) had hemorrhage in zone Ⅰ, Ⅱ and Ⅲ. One eye (0.4%) had hemorrhage in zoneⅠonly. Twelve eyes (13.8%) had hemorrhage in zone Ⅱ only. None had hemorrhage in zone Ⅲ only. The severity of RH was grade Ⅰ in 13 of 87 eyes (14.9%), grade Ⅱ in 33 of 87eyes (37.9%), and grade Ⅲ in 41 of 87 eyes (47.1%). Fourteen of 58 newborns with RH (24.1%) were lost to follow-up. Forty-four of 58 newborns with RH (75.9%) were reexamined one month after birth and all the RH disappeared entirely. There were no statistically significant differences among the incidences of RH of the different gender (chi;2=0.018,P=0.893), parity（chi;2=0.772,P=0.380）, birth weight（chi;2=1.611,P=0.447）and maternal age (chi;2=0.915,P=0.339). The incidence of RH was higher for vaginal delivery than that for cesarean section delivery (chi;2=3.073,P＜0.05). Conclusions The RH in newborn is located in the superficial retina, mostly located in zone Ⅰor zone Ⅱ, and resolves itself within one month after birth. The RH in newborns is related to the mode of delivery, but not related to gender, parity, birth weight or maternal age.
Objective To investigate the related factors of the retinal hemorrhage in high-risk infants (HRI). Methods Eight hundred and sixty HRI with histories of high-risk pregnancy and/or neonatal asphyxia after 1-5 days of birth were enrolled in this study.In 860 cases of HRI, 498 infants were vaginal delivery and 362 infants were delivered through cesarean sections. Among 498 vaginal delivered infants, 407 infants were eutocia and 91 infants were with forceps delivery; 298 infants were born following normal labor, 102 infants experienced prolonged labor, and 98 infants were urgent birth. The retinal hemorrhages were observed and conditions were graded into three degrees of Ⅰ, Ⅱ, and Ⅲ. Conditions of neonatal asphyxia were evaluated based on criteria of Apgar score. The incidence of retinal hemorrhage in the different types of deliveries and labor processes were compared, and the relationship between degree of retinal hemorrhage and grade of neonatal asphyxia were analyzed. Results In 860 cases of HRI, retinal hemorrhages were found in 202 infants (23.5%). Within these 202 infants, 75 infants (37.1%) were Ⅰ degree retinal hemorrhage, 75 infants (37.1%) were Ⅱ degree retinal hemorrhage, and 52 infants (25.8%) were Ⅲ degree retinal hemorrhage. In these 202 infants of retinal hemorrhage, 172 infants (85.1%) had histories of asphyxia; 119 infants (69.2%) were graded as mild asphyxia-risk, and 53 infants (30.8%) were graded as severe asphyxiarisk. There was a statistical difference of the degree of the retinal hemorrhage between the mild and severe asphyxia-risk infants (chi;2=34.61,P＜0.01). The incidence of retinal hemorrhage after vaginal delivery was higher than cesarean section delivery with significant statistical difference (chi;2=30.73,P＜0.01). The incidence of retinal hemorrhage after forceps delivery was significantly higher than eutocia with statistical difference (chi;2=62.78,P＜0.01). Both prolonged and urgent childbirth had statistically significant higher incidences of retinal hemorrhage compared to normal labor in the process of vaginal delivery (chi;2=45.86, 71.51; P＜0.01). Asphyxia, types of delivery, prolonged and urgent labors were risk factors of retinal hemorrhage for HRI (r=7.46,4.87,15.03,6.47;P＜0.01). Conclusions The incidence of retinal hemorrhage in high-risk infant was 23.5%. And, asphyxia, types of delivery, prolonged and urgent labors may play roles of risk factor in retinal hemorrhage of HRI.
Objective To analyze the clinical features of retinal detachment in macular spontaneous hemorrhage to improve the level of diagnosis and treatment of this disease. Methods The serial clinical data of 23 patients (23 eyes) with subretinal hemorrhage in macular region with the area over 4DDtimes;5DD who were diagnosed in our hospital from Sep, 1998 to Mar, 2003 were analyzed retrospectively. The patients included 12 males (12 eyes) and 11 females (11 eyes) with the average age of 64.1 (47-75). Fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and B-scan examination were performed on the patients to analyze the pathogenic factors, and the visual acuity and manifestation of ocular fundus were observed during the 8-24 months followed-up period. Results The visual acuity decreased to less than 0.2 or light perception suddenly in all affected eyes. In 23 eyes, choroidal neovascularization (CNV) of age-related macular degeneration (AMD) was found in 7, polypoidal choroidal vasculopathy (PCV) was in 5, retinal macroaneurysm was in 2, and unknow pathogenic factor in 9. Among the 23 eyes, hemorrhage was absorbed and no cicatritial formation at the fovea in 3 eyes with the visual acuity of 0.4-0.8; scar and pigment proliferation in the hemorrhage area were seen in 12 eyes with the visual acuity of finger counting (FC) to 0.2; combined vitreous hemorrhage was found in 8 eyes, including massive scar in the macular area in 3 who had undergone vitrectomy with the visual acuity of FC/66cm to 0.2 and blindness in the other 5 eyes. Conclusion Spontaneous hemorrhagic retinal detachment always arises in old people whose symptoms were sudden decrease or loss of the visual acuity. The configuration of the hemorrhage is local and diffuse. The prognosis of the visual acuity of most of the patients is poor due to the serious tissue injury in macula area. (Chin J Ocul Fundus Dis, 2006, 22: 228-231)
Objective To detect the clinical characters and the classification of the congenital retinal vascular anomalies. Methods Nine cases (12 eyes) of congenital retinal vascular anomalies were examined by ocular examination and fundus fluorescein angiography (FFA), in which 3 cases (4 eyes) were examined by indocyanine green angiography (ICGA) simultaneously. Results The congenital retinal vascular anomalies were located at the posterior pole in 8 cases (10 eyes), and extended to peripheral retina in 1 case (2 eyes). Congenital retinal vascular anomalies were classified as follows: congenital retinal macrovessel (1 case, 1 eye); congenital retinal arteriolar tortuosity (2 cases, 3 eyes); inherited retinal venous beading (1 case, 2 eyes); and congenital prepapillary vascular loops (5 cases, 6 eyes). Four cases (5 eyes) were associated with spontaneous hemor rhage induced by physical exertion (Valsalva maneuver). Conclusion Most of the congenital retinal anomalies are located at the posterior pole, involving arteries and veins, and can be associated with spontaneous hemorrhage induced by Valsalva maneuver. (Chin J Ocul Fundus Dis，2003，19：269-332)