TY - JOUR
T1 - Determining the Tractional Forces on Vitreoretinal Interface Using a Computer Simulation Model in Abusive Head Trauma
AU - Suh, Donny W.
AU - Song, Helen H.
AU - Mozafari, Hozhabr
AU - Thoreson, Wallace B.
N1 - Funding Information:
Biosketch Donny W. Suh, MD,FAAP,works at Children’s Hospital and Medical Center as the Chief ofOphthalmology Service and as an associate professor at the Truhlsen Eye Institute, Department of Ophthalmology and Visual Sciences and Department of Pediatrics at University of Nebraska Medical Center. He completed his pediatric ophthalmology and strabismus fellowship at the Wilmer Eye Institute, Johns Hopkins University School of Medicine. He completed his ophthalmology residency at the Eye Institute, Medical College of Wisconsin, and received his medical doctorate from Baylor College of Medicine in Houston, Texas. He received his bachelor of arts in biochemistry from Rice University in Houston, Texas. Dr. Suh is an active volunteer faculty of ORBIS Flying Eye Hospital medical mission programs since 2000, and has traveled to South America, Europe, Asia, and Africa to provide medical and surgical services as well as to teach the local ophthalmologists. He has been a Chief Editor for Medscape Online Reference since March 2016 and has publishedover 100 articles in major journals and chapters in major textbooks. Dr. Suh was Chairman of the Annual Meeting Program Committee in pediatric ophthalmology for the American Academy of Ophthalmology and President of Polk County Medical Society in Iowa for 2014, representing more than 1,200 physicians in central Iowa. He is also actively involved with teaching medical students and residents in pediatrics, internal medicine, family medicine, and ophthalmology in Iowa and Nebraska. He is Director of Fellowship in Pediatric Ophthalmology and Adult Strabismus at the University of Nebraska Medical Center. He is currently involved in 20 institutional review board (IRB)-approved research projects and actively working with University of Nebraska Medical Center students, residents and fellows in pediatrics and ophthalmology. Dr. Suh is actively involved with Pediatric Eye Disease Investigation Group research, which is sponsored by the National Eye Institute. He has numerous inventions with patents for surgical equipment and medical devices. He is an Ophthalmology Executive Committee member for the American Academy of Pediatrics and helped to establish guidelines for pediatricians for pediatric eye care. He is also chairman of the Membership Committee for American Academy of Pediatrics Ophthalmology Section and Annual Meeting Program Committee Chair for the Association for Research in Vision and Ophthalmology in his subspecialty. He has been voted “Best Doctor in America” and “America’s Top Ophthalmologist” from 2003 to 2018. He currently owns 6 patents for new inventions and has been voted as the University of Nebraska Medical Center Inventor of the Year.
Publisher Copyright:
© 2020
PY - 2021/3
Y1 - 2021/3
N2 - Purpose: Abusive head trauma (AHT) is the leading cause of infant death and long-term morbidity from injury. The ocular consequences of AHT are controversial, and the pathophysiology of retinal research findings is still not clearly understood. It has been postulated that vitreoretinal traction plays a major role in the retinal findings. A computer simulation model was developed to evaluate the vitreoretinal traction and determine whether the distribution of forces in different layers and locations of the retina can explain the patterns of retinal hemorrhage (RH) seen in AHT. Design: Computer simulation model study. Methods: A computer simulation model of the pediatric eye was developed to evaluate preretinal, intraretinal, and subretinal stresses during repetitive shaking. This model was also used to examine the forces applied to various segments along blood vessels. Results: Calculated stress values from the computer simulation ranged from 3-16 kPa at the vitreoretinal interface through a cycle of shaking. Maximal stress was observed at the periphery of the retina, corresponding to areas of multiple vessel bifurcations, followed by the posterior pole of the retina. Stress values were similar throughout all 3 layers of the retina (preretinal, intraretinal, and subretinal layers). Conclusions: Ocular manifestations from AHT revealed unique retinal characteristics. The model predicted stress patterns consistent with the diffuse retinal hemorrhages (RH) typically found in the posterior pole and around the peripheral retina in AHT. This computer model demonstrated that similar stress forces were produced in different layers of the retina, consistent with the finding that retinal hemorrhages are often found in multiple layers of the retina. These data can help explain the RH patterns commonly found in AHT.
AB - Purpose: Abusive head trauma (AHT) is the leading cause of infant death and long-term morbidity from injury. The ocular consequences of AHT are controversial, and the pathophysiology of retinal research findings is still not clearly understood. It has been postulated that vitreoretinal traction plays a major role in the retinal findings. A computer simulation model was developed to evaluate the vitreoretinal traction and determine whether the distribution of forces in different layers and locations of the retina can explain the patterns of retinal hemorrhage (RH) seen in AHT. Design: Computer simulation model study. Methods: A computer simulation model of the pediatric eye was developed to evaluate preretinal, intraretinal, and subretinal stresses during repetitive shaking. This model was also used to examine the forces applied to various segments along blood vessels. Results: Calculated stress values from the computer simulation ranged from 3-16 kPa at the vitreoretinal interface through a cycle of shaking. Maximal stress was observed at the periphery of the retina, corresponding to areas of multiple vessel bifurcations, followed by the posterior pole of the retina. Stress values were similar throughout all 3 layers of the retina (preretinal, intraretinal, and subretinal layers). Conclusions: Ocular manifestations from AHT revealed unique retinal characteristics. The model predicted stress patterns consistent with the diffuse retinal hemorrhages (RH) typically found in the posterior pole and around the peripheral retina in AHT. This computer model demonstrated that similar stress forces were produced in different layers of the retina, consistent with the finding that retinal hemorrhages are often found in multiple layers of the retina. These data can help explain the RH patterns commonly found in AHT.
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U2 - 10.1016/j.ajo.2020.06.020
DO - 10.1016/j.ajo.2020.06.020
M3 - Article
C2 - 32663454
AN - SCOPUS:85096008921
VL - 223
SP - 396
EP - 404
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
SN - 0002-9394
ER -