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May 2004

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

In reply

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.