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  • Resolution patterns and duration of retinal haemorrhages measured by two-dimensional retinal area pixel counts from sequential retinal imaging in childhood encephalopathies: a morphometric study

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Original article
Resolution patterns and duration of retinal haemorrhages measured by two-dimensional retinal area pixel counts from sequential retinal imaging in childhood encephalopathies: a morphometric study
  1. Patricia A Jones1,
  2. Robert A Minns2,
  3. Anamika Tandon3,
  4. Brian Fleck2,4,
  5. Alan Mulvihill2,4
  1. 1Child Life and Health, University of Edinburgh, Edinburgh, UK
  2. 2Royal Hospital for Sick Children, NHS Lothian, Edinburgh, UK
  3. 3Paediatric Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  4. 4Paediatric Ophthalmology, Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK
  1. Correspondence to Dr Robert A Minns; Robert.Minns{at}ed.ac.uk

Abstract

Objective To determine the time to resolution of different-layered retinal haemorrhages (RHs), and to describe the main patterns of their resolution in a group of children with encephalopathies.

Methods and analysis From a prospective study of 114 children with traumatic and non-traumatic encephalopathies, 429 selected individual RHs (iRHs) from 18 children were serially imaged from admission using a RetCam. Photoshop and Scion Imaging software allowed calculation of RH area in pixels.

Results Two patterns of the resolution were recognised on the basis of area measurements: a progressive decrease (pattern A, 60% of iRHs), and a form of asymmetrical decay in which iRHs first increased in size before then progressively decreasing (pattern B, 35% of iRHs). Within the pattern A group, the Kaplan-Meier median survival time (MST) (95% CI) was 10 (9.3 to 10.7) days for intra-RHs (IRHs) and 38 (10.8 to 65.2) days for pre-RHs (PRHs), log rank (Mantel-Cox) p=0.001. The mean percentage reduction in area per day was 12.5% for all iRHs, 14.5% for IRHs and 6.3% for PRHs.

Conclusion Serial area measurements of iRHs revealed that 35% haemorrhages became temporarily larger before decreasing to resolution. Serially imaged selected RHs showed a longer MST for PRHs than for IRHs.

  • child health (paediatrics)
  • retina
  • imaging
  • trauma

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjophth-2019-000275

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    Footnotes

    • Contributors RAM, PAJ, BF and AM planned the study. PAJ, BF, AT and AM conducted the study. RAM and PAJ analysed and submitted the study. RAM is responsible for the overall conduct of the study and is the guarantor of the study.

    • Funding Grants were provided by the RS Macdonald Charitable Trust, the Royal College of Surgeons of Edinburgh and the Friends of the Sick Kids Foundation, Edinburgh, Scotland.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval was granted by the Lothian research ethics committee (LREC 2004/6/2).

    • Provenance and peer review Not commissioned; externally peer reviewed.