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Correspondence |

Extension of Retinal Hemorrhage Into the Vitreous of a Shaken BabyThrough a Break in the Internal Limiting Membrane

Geoffrey G. Emerson, MD, PhD
Arch Ophthalmol. 2004;122(5):792. doi:10.1001/archopht.122.5.792-a.
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Lincoff et al1 presented evidencein the January 2003 issue of the ARCHIVES that a vitreous cloud of erythrocytefragments can emanate from subretinal and intraretinal hemorrhage by passingthrough an intact internal limiting membrane (ILM). In their study, autologousblood was injected into the subretinal space of rabbit eyes, which were followedacross time until a vitreous cloud appeared. At the first sign of cloud, vitrectomywas performed, and the eyes were searched for an ILM break in vivo by usingsurgical microscopy, in vitro serial sections, and light and electron microscopy.No break in the ILM was found underlying the vitreous cloud where it appearedto emanate from the retina.

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Photomicrograph of peripheral retina shows that erythrocytes froma retinal hemorrhage have spilled through an overlying break (arrow) in theinternal limiting membrane (hematoxylin-eosin, original magnification ×400).

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