Experimental investigation of whether perimacular retinal folds occur due to optic nerve traction in severe head trauma

2023 Fiscal Year Final Research Report

• Project/Area Number: 20K10570
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 58040:Forensics medicine-related
• Research Institution: Mie University (2021-2023); Kurume University (2020)
• Principal Investigator: OSHIMA TORU 三重大学, 医学系研究科, 准教授 (70464427)
• Project Period (FY): 2020-04-01 – 2024-03-31
• Keywords: 揺さぶられっ子症候群 / 網膜分離 / 眼軸長 / 眼底出血 / 法医病理 / 子どもの虐待 / 網膜ひだ

Outline of Final Research Achievements

Severe abusive head trauma causes perimacular retinal fold. It is believed that oscillation of the vitreous body caused by head acceleration leads to retinal traction, which might result in these folds. This study aimed to investigate whether optic nerve traction during severe head injury affects the axial length and elucidate the mechanism underlying perimacular retinal fold formation. A comparison of the axial length during experimental optic nerve traction under normal conditions did not reveal any differences. We also investigated the influence of posterior vitreous detachment on changes in axial length due to traction; however, no effect was observed. In children <2 years of age, a comparison of the axial length under normal and traction conditions revealed no difference. Perimacular retinal folds are believed to be caused by traction on the retina due to oscillation of the vitreous body, as conventionally thought.

Free Research Field

法医学

Academic Significance and Societal Importance of the Research Achievements

本研究の結果から，眼球は眼窩内脂肪組織によって囲まれており，後頭部打撲や揺さぶりによって，眼球の形状変化が生じて出血性網膜ひだができるという成傷機序は考え難いことがわかった．このことから，出血性網膜ひだは従来通り，硝子体の振盪による網膜の前方牽引で生じていると考えられた．児童虐待による頭部外傷は家庭内という密室で起こるため司法判断が難しく，転落事故と明瞭に鑑別できないことが裁判上で大きな問題となっている．出血性網膜ひだは従来通り，重症頭部加速度損傷や揺さぶりに伴う眼損傷と考えられ，虐待に伴う頭部外傷と家庭内事故による低所転落等との成傷機転の鑑別に重要な所見と考えられた．