Agarwal Aniruddha, Aggarwal Kanika, Dogra Mohit, Kumar Aman, Akella Madhuri, Katoch Deeksha, Bansal Reema, Singh Ramandeep, Gupta Vishali
Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
Ophthalmol Retina. 2019 Feb;3(2):170-177. doi: 10.1016/j.oret.2018.09.008. Epub 2018 Sep 20.
Dengue maculopathy can present with a unique constellation of features resulting in significant central visual morbidity. We aim to describe various findings of dengue-induced inflammatory, ischemic foveolitis, and outer maculopathy (DIII-FOM) and assess the serial changes in vitreous inflammation, retinal structure, and vascularity using swept-source OCT (SS-OCT) and OCT angiography (OCTA).
Retrospective case series.
A total of 32 eyes (16 patients; 7 male) with dengue fever (positive serology for NS1 antigen) were enrolled in the study.
In this study, serial assessments of ocular findings and imaging using fundus photography, SS-OCT, and SS-OCTA were performed. All the patients received 0.5 to 1 mg/kg/day oral prednisolone that was tapered over 4 to 6 weeks.
Outcome measures included functional change, that is, improvement in best-corrected visual acuity (BCVA), structural changes in the vitreous and retinal layers on SS-OCT, and retinal perfusion on OCTA.
The mean age of the patients was 29.17±10.91 years. Swept-source OCT showed vitreous cells (32 eyes; 100%), disruption of outer retinal layers (foveolitis) (24 eyes; 75%), and conical foveal elevation (22 eyes; 68.75%). After initiation of systemic corticosteroids, all the eyes showed resolution of vitreous cells and improvement in the integrity of retinal layers. Mean BCVA improved from an initial 0.80±0.33 logarithm of the minimum angle of resolution (logMAR) to 0.23±0.36 logMAR. Retinal plexus flow deficit (superficial plexus: 0.10±0.12 mm; deep plexus: 0.29±0.13 mm) persisted in all eyes and correlated well with initial BCVA (P < 0.05).
The pathophysiology of dengue maculopathy involves both ischemic and inflammatory components. Early institution of corticosteroid therapy may help in resolution of the inflammation-driven vitreoretinal alterations, but ischemia of the deep retinal plexuses may persist and may be the cause of permanent structural and functional changes.
登革热黄斑病变可呈现一系列独特特征，导致严重的中心视力损害。我们旨在描述登革热诱发的炎症性、缺血性黄斑中心凹炎及外层黄斑病变（DIII-FOM）的各种表现，并使用扫频源光学相干断层扫描（SS-OCT）和光学相干断层扫描血管造影（OCTA）评估玻璃体炎症、视网膜结构和血管的系列变化。
回顾性病例系列研究。
共有32只眼（16例患者；7例男性）因登革热（NS1抗原血清学阳性）纳入本研究。
本研究采用眼底照相、SS-OCT和SS-OCTA对眼部表现和影像学进行系列评估。所有患者接受0.5至1mg/kg/天的口服泼尼松龙治疗，并在4至6周内逐渐减量。
观察指标包括功能变化，即最佳矫正视力（BCVA）的改善、SS-OCT上玻璃体和视网膜层的结构变化以及OCTA上的视网膜灌注情况。
患者的平均年龄为29.17±10.91岁。扫频源光学相干断层扫描显示玻璃体细胞（32只眼；100%）、视网膜外层破坏（黄斑中心凹炎）（24只眼；75%）和黄斑中心凹锥形隆起（22只眼；68.75%）。开始全身使用皮质类固醇后，所有眼的玻璃体细胞均消失，视网膜层完整性得到改善。平均BCVA从初始的最小分辨角对数（logMAR）0.80±0.33提高到0.23±0.36 logMAR。所有眼中视网膜神经丛血流缺损（浅层神经丛：0.10±0.12mm；深层神经丛：0.29±0.13mm）持续存在，且与初始BCVA密切相关（P<0.05）。
登革热黄斑病变的病理生理学涉及缺血和炎症成分。早期应用皮质类固醇治疗可能有助于消退炎症驱动的玻璃体视网膜改变，但深层视网膜神经丛的缺血可能持续存在，并可能是永久性结构和功能改变的原因。
