Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 12, Number 4—April 2006
Letter

Maculopathy in Dengue Fever

On This Page
Article Metrics
4
citations of this article
EID Journal Metrics on Scopus

Cite 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 (24). 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.

Top

Daniel Hsien-Wen Su*Comments to Author  and Soon-Phaik Chee*†‡

Author affiliations: *Singapore National Eye Centre, Singapore; †National University of Singapore, Singapore; ‡Singapore Eye Research Institute, Singapore

Top

References

  1. Chlebicki  MP, Ang  B, Barkham  T, Laude  A. Retinal hemorrhages in 4 patients with dengue fever. Emerg Infect Dis. 2005;11:7702.PubMed
  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;5:2430.PubMed
  3. Haritoglou  C, Scholz  F, Bialaslewicz  A, Klauss  V. Ocular manifestations in dengue fever [article in German]. Ophthalmologe. 2000;97:4336. DOIPubMed
  4. Haritoglou  C, Dotse  SD, Rudolph  G, Stephan  CM, Thurau  SR, Klauss  V. A tourist with dengue fever and visual loss. Lancet. 2002;360:1070. DOIPubMed
  5. Lim  WK, Mathur  R, Koh  A, Yeoh  R, Chee  SP. Ocular manifestations of dengue fever. Ophthalmology. 2004;111:205764. DOIPubMed

Top

Cite This Article

DOI: 10.3201/eid1204.051476

Related Links

Top

Table of Contents – Volume 12, Number 4—April 2006

Comments

Please use the form below to submit correspondence to the authors or contact them at the following address:

Daniel H.-W. Su, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore 168751; fax: 65-62263395

Send To

character(s) remaining.

Comment submitted successfully, thank you for your feedback.

Top

Page created: January 24, 2012
Page updated: January 24, 2012
Page reviewed: January 24, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external