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Letter
Maculopathy in Dengue Fever
Daniel Hsien-Wen Su*
and Soon-Phaik Chee*†‡
*Singapore National Eye Centre, Singapore; †National University of Singapore,
Singapore; and ‡Singapore Eye Research Institute, Singapore
Suggested
citation for this article
To the Editor: A recent article by Chlebicki et al (1)
described 4 patients hospitalized for dengue fever who were found to have
retinal hemorrhages. These patients reported reduced visual acuity and
metamorphopsia, i.e., distorted visual images attributable to intrinsic
retinal disease involving the macula; macular hemorrhages and exudates
were found on retinal examination. The authors concluded that the retinal
hemorrhages were responsible for the patients' visual symptoms.
This conclusion is misleading because retinal hemorrhages alone cause
scotomas. Rather, the accumulation of subretinal fluid in the macula results
in metamorphopsia and blurring of vision. In previous reports of patients
in whom macular changes developed from dengue fever, some were found to
have macular hemorrhages (2–4). In addition, clinical
examination and investigation of these patients showed vasculopathologic
changes in the macular region that affected the retinal and choroidal
blood vessels (5), although the tissues of the
periphery tended to be spared. A fluorescein angiograph of the retina
showed knobby hyperfluorescence of the retinal arterioles with minimal
leakage, as well as some spots of leakage at the level of the retinal
pigment epithelium. An indocyanine green angiograph showed diffuse hyperfluorescence
of the choroid. These pathologic changes in the macula were the most likely
cause of the blurring of vision in such patients, which has been the case
in our experience.
The article by Chlebicki et al. did not state whether these procedures
had been performed on their patients to confirm or exclude retinal or
choroidal vasculopathy in the macula. Therefore, these authors would have
had difficulty concluding that retinal hemorrhages caused blurring of
vision and metamorphopsia in patients with dengue maculopathy.
References
- Chlebicki MP, Ang B, Barkham T, Laude A. Retinal
hemorrhages in 4 patients with dengue fever. Emerg Infect Dis. 2005;11:770–2.
- Wen KH, Sheu MM, Chung CB, Wang HZ, Chen CW. The
ocular fundus findings in dengue fever [article in Chinese]. Gaoxiong
Yi Xue Ke Xue Za Zhi. 1989;5:24–30.
- Haritoglou C, Scholz F, Bialaslewicz A, Klauss V. Ocular
manifestations in dengue fever [article in German]. Ophthalmologe.
2000;97:433–6.
- Haritoglou C, Dotse SD, Rudolph G, Stephan CM, Thurau SR, Klauss V.
A
tourist with dengue fever and visual loss. Lancet. 2002;360:1070.
- Lim WK, Mathur R, Koh A, Yeoh R, Chee SP. Ocular
manifestations of dengue fever. Ophthalmology. 2004;111:2057–64.
Suggested citation
for this article:
Su DHW, Chee SP. Maculopathy
in dengue fever [letter]. Emerg Infect Dis [serial on the Internet]. 2006
Apr [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol12no04/05-1476.htm
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