Dr Geoffrey Emerson reports that whole erythrocytes from a retinal hemorrhagebroke through the internal limiting membrane to cloud the vitreous in a shakenbaby. His photomicrograph shows a portion of retina containing blood, predominantlyin the nerve fiber layer and ganglion cell layer. It is also focally presentin the inner nuclear layer and outer plexiform layer; the receptor layer isspared. There is nerve fiber and ganglion cell necrosis in the nerve fiberlayer where only blood and pillars of Müllerian glia remain; ganglioncells are conspicuously absent. Associated with nerve fiber layer hemorrhageand ganglion cell loss is a discontinuity in the internal limiting membranewith 3 indiscernible cells or fragments internal to it. A photomicrographof the vitreous cloud demonstrating intact erythrocytes would support theauthor's conclusion. However, the photomicrograph presented suggests severedamage to Müllerian glia centering on inner nuclear and ganglion celllayers.
Schubert H, Stopa M, Lincoff H. Extension of Retinal Hemorrhage Into the Vitreous of a Shaken BabyThrough a Break in the Internal Limiting Membrane—Reply. Arch Ophthalmol. 2004;122(5):792–793. doi:10.1001/archopht.122.5.792-b
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