Axial myopia associated with dense vitreous hemorrhage of the neonate

Background: Various forms of visual deprivation during infancy have been shown to cause axial myopia. Although infantile vitreous hemorrhage is associated with myopic progression, it is unknown whether this aberrant development is refractive or axial. The primary objectives of this study were to investigate this abnormal myopic development and to determine what duration of dense vitreous hemorrhage is sufficient to cause significant amblyopia in neonates. Methods: Four infants with dense unilateral vitreous hemorrhages in the first weeks of life underwent serial evaluations of the posterior segment, refractive error, and A-scan ultrasonography. Results: Three of the 4 infants underwent successful lens-sparing vitrectomy between 3 and 6 weeks after the onset of the hemorrhage, and all 3 developed axial myopia and dense amblyopia during a mean follow-up of 29.7 months (range, 16 to 38 months). At the most recent follow-up examination, the mean myopic error of the 3 eyes that required surgery was -11.42 D with a mean ocular axial length difference of 3.45 mm between the affected and the unaffected eyes. The fourth child had a dense hemorrhage soon after birth that cleared by 11 days of age. Although this patient developed amblyopia and a mild myopic error of the involved eye, there was no significant increase in axial length. Conclusions: Dense hemorrhages persisting in the neonatal vitreous for 4 weeks or longer appear to cause axial myopia and severe amblyopia. Surgical intervention before this time should be considered to avert deprivation amblyopia and to retard axial myopia.