Exploring the Vitreoretinal Interface: A Key Instigator of Unique Retinal Hemorrhage Patterns in Pediatric Head Trauma
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Purpose: Various types of trauma can cause retinal hemorrhages in children, including accidental and nonaccidental headtrauma. We used animal eyes and a finite element model of the eye to examine stress patterns produced during purely linearand angular accelerations, along with stresses attained during simulated repetitive shaking of an infant. Methods: Using sheep and primate eyes, sclerotomy windows were created by removing the sclera, choroid, and retinalpigment epithelium to expose the retina. A nanofiber square was glued to a 5 mm2 area of retina. The square was pulled andseparated from vitreous while force was measured. A finite element model of the pediatric eye was used to computationallymeasure tension stresses during shaking. Results: In both sheep and primate eyes, tension stress required for separation of retina from vitreous range from 1 to 5kPa. Tension stress generated at the vitreoretinal interface predicted by the computer simulation ranged from 3 to 16 kPaduring a cycle of shaking. Linear acceleration generated lower tension stress than angular acceleration. Angular accelerationgenerated maximal tension stress along the retinal vasculature. Linear acceleration produced more diffuse force distributioncentered at the poster pole. Conclusions: The finite element model predicted that tension stress attained at the retina during forcible shaking of an eyecan exceed the minimum threshold needed to produce vitreoretinal separation as measured in animal eyes. Furthermore, theresults show that movements that involve significant angular acceleration produce strong stresses localized along the vasculature,whereas linear acceleration produces weaker, more diffuse stress centered towards the posterior pole of the eye.
Abstract
Purpose: Various types of trauma can cause retinal hemorrhages in children, including accidental and nonaccidental headtrauma. We used animal eyes and a finite element model of the eye to examine stress patterns produced during purely linearand angular accelerations, along with stresses attained during simulated repetitive shaking of an infant. Methods: Using sheep and primate eyes, sclerotomy windows were created by removing the sclera, choroid, and retinalpigment epithelium to expose the retina. A nanofiber square was glued to a 5 mm2 area of retina. The square was pulled andseparated from vitreous while force was measured. A finite element model of the pediatric eye was used to computationallymeasure tension stresses during shaking. Results: In both sheep and primate eyes, tension stress required for separation of retina from vitreous range from 1 to 5kPa. Tension stress generated at the vitreoretinal interface predicted by the computer simulation ranged from 3 to 16 kPaduring a cycle of shaking. Linear acceleration generated lower tension stress than angular acceleration. Angular accelerationgenerated maximal tension stress along the retinal vasculature. Linear acceleration produced more diffuse force distributioncentered at the poster pole. Conclusions: The finite element model predicted that tension stress attained at the retina during forcible shaking of an eyecan exceed the minimum threshold needed to produce vitreoretinal separation as measured in animal eyes. Furthermore, theresults show that movements that involve significant angular acceleration produce strong stresses localized along the vasculature,whereas linear acceleration produces weaker, more diffuse stress centered towards the posterior pole of the eye.
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