Surgical Management of Pre-Macular Haemorrhage (Sub Internal Limiting Bleed) in Children with Non-Accidental Injury

1. Suhaili Ibrahim
2. Nor Azita Ahmad Tarmidzi
3. Sunder Ramasamy
4. Jamaliah Rahmat
5. Joseph Alagaratnam
6. TVN Karunakar

Hospital Kuala Lumpur, Malaysia

Purpose: To report results of vitreoretinal surgery for pre-macular haemorrhage in eyes of patients suffering from non accidental injury.

Methods: A retrospective observational and interventional case series analysis

Results: Twelves eyes of nine patients underwent lens sparing trans pars plana/ trans pars plicata vitrectomy between January 2009 and December 2009. Patients' age ranged from 3 months to 14 months. Indication for vitreoretinal surgery was persistent pre-macular haemorrhage which is loacted in a macular schitic cavity under internal limiting membrane. Clinically in most of the eyes resolution of haemorrhage was immediate or by the first post op day and assessable visual function was achieved in all except for one patient. Duration of follow-up ranged from 5 months to 15 months.

Conclusion: Lens sparing Vitrectomy for pre-macular haemorrhage in children is a safe and effective alternative to observation, offering visual rehabilitation and prevents amblyopia and complications due to persisting haemorrhage like macular degeneration, scarring, tractional changes and macular hole formation.Hence non resolving vitreous haemorrhage secondary to NAI needs to be evaluated and taken up for surgery within few weeks of diagnosis.