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We performed a retrospective, single-center autopsy case series of fifteen neonates, infants, and young children with hemorrhagic retinopathy identified by postmortem indirect ophthalmoscopy (2016\u20132024). Histological evaluation focused on ILM attachment at retinal fold apices and separation from adjacent retina. Decedents ranged from birth to 55 months (mean, 10.3 months); manners of death included natural (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096), accidental (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095), homicide (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091), and undetermined (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093). None involved abusive head trauma. In all cases, Lange\u2019s folds had the ILM attached at fold apices and detached from adjacent retina, a pattern previously attributed to vitreoretinal traction from ocular acceleration-deceleration in abusive head trauma or shaken baby syndrome. ILM attachment at retinal fold apices with adjacent retinal separation lacks diagnostic specificity for vitreoretinal traction from ocular acceleration-deceleration. These findings highlight the risk of misinterpretation and underscore the critical need for prudent, evidence-based evaluations in suspected child abuse investigations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key points<\/jats:title>\n                    <jats:p>\n                      \u2022\n                      <jats:italic>Vitreoretinal traction (VRT) has been proposed as a mechanism contributing to retinal fold formation in suspected abusive head trauma.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      \u2022\n                      <jats:italic>Histopathologic findings of internal limiting membrane (ILM) attachment at retinal fold apices, with separation from the adjacent retina, have been cited as supportive of VRT.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      \u2022\n                      <jats:italic>The configuration of the ILM on Lange\u2019s folds and adjacent retina resembles histological features described on pathological retinal folds.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      \u2022\n                      <jats:italic>A definitive causal relationship between repetitive ocular acceleration\u2013deceleration forces (shaking) and retinal fold formation via VRT has not been established.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      \u2022\n                      <jats:italic>ILM attachment patterns on retinal folds are insufficient to confirm VRT as the etiologic mechanism, underscoring the need for cautious interpretation of ocular findings in clinical and forensic assessments.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12024-026-01253-2","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:45:30Z","timestamp":1777524330000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Histologic features of Lange\u2019s folds: implications for diagnosing retinal folds due to vitreoretinal traction in pediatric eyes"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4705-3208","authenticated-orcid":false,"given":"Ashley L.","family":"Smith","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8500-3782","authenticated-orcid":false,"given":"Tammy","family":"Sexton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0657-7164","authenticated-orcid":false,"given":"William T.","family":"Harrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6536-8629","authenticated-orcid":false,"given":"Anna G.","family":"McDonald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6765-0663","authenticated-orcid":false,"given":"Patrick E.","family":"Lantz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"issue":"5","key":"1253_CR1","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1016\/S0161-6420(86)33688-1","volume":"93","author":"MJ Greenwald","year":"1986","unstructured":"Greenwald MJ, Weiss A, Oesterle CS, Friendly DS. 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Harrison, McDonald, and Lantz have served as consultants and witnesses for prosecution and defense in cases of child abuse. Dr. Smith and T. Sexton have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Competing interests"}}]}}