Mukherji Payal, Shilpy Neha, Gupta Rajiv Kumar
Department of Ophthalmology, Regional Institute of Ophthalmology (RIO), Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India.
Indian J Ophthalmol. 2023 Oct;71(10):3394-3398. doi: 10.4103/IJO.IJO_3389_22.
To assess the frequency and distribution of retinal changes in children suffering from cerebral malaria (CM), study the correlation between fundal changes and severity of disease, visual outcome, and survival of patients.
An observational, cross-sectional study was done on pediatric patients, suffering from CM in a tertiary care center in eastern India. A complete ophthalmological examination was done and findings were tabulated. Their hospital admission records were checked for severity of coma, recovery, and prognosis. Data were analyzed with SPSS software, and P value < 0.05 was considered statistically significant.
Total 113 children of age group 0-18 years (mean age 7.88 ± 0.56 years) were enrolled in the study. Seventy-seven children (68.14%) had retinal changes. Most common retinal signs associated with malarial retinopathy were white centered hemorrhage and papilledema (53.09% each), followed by retinal whitening (51.33%) and vessel changes (39.82%). The correlation between the presence of white centered retinal hemorrhages and visual prognosis was found to be statistically significant (P = 0.001). Patients with Grade 4 parasitemia showed maximum retinal signs with a significant correlation between the severity of papilledema and parasite load (P = 0.037). Eighty-six patients (76.11%) survived and 27 patients (23.89%) died. All 27 patients who died showed all four signs of malarial retinopathy. Out of these, patients with retinal whitening suffered from severe coma, and this correlation was found to be statistically significant (P = 0.002).
Presence of retinal signs in patients with CM is associated with severe disease (high parasite load), poor visual outcome, and increased mortality.
评估脑型疟疾（CM）患儿视网膜病变的发生率及分布情况，研究眼底改变与疾病严重程度、视力预后及患者生存率之间的相关性。
在印度东部一家三级医疗中心，对患有CM的儿科患者进行了一项观察性横断面研究。进行了全面的眼科检查，并将检查结果制成表格。检查他们的医院入院记录，以了解昏迷的严重程度、恢复情况和预后。使用SPSS软件进行数据分析，P值<0.05被认为具有统计学意义。
共有113名年龄在0至18岁（平均年龄7.88±0.56岁）的儿童纳入研究。77名儿童（68.14%）有视网膜病变。与疟疾性视网膜病变相关的最常见视网膜体征是中心白色出血和视乳头水肿（各占53.09%），其次是视网膜变白（51.33%）和血管改变（39.82%）。发现中心白色视网膜出血的存在与视力预后之间的相关性具有统计学意义（P = 0.001）。4级寄生虫血症患者的视网膜体征最多，视乳头水肿的严重程度与寄生虫负荷之间存在显著相关性（P = 0.037）。86名患者（76.11%）存活，27名患者（23.89%）死亡。所有27名死亡患者均表现出疟疾性视网膜病变的所有四种体征。其中，视网膜变白的患者昏迷严重，这种相关性具有统计学意义（P = 0.002）。
CM患者出现视网膜体征与严重疾病（高寄生虫负荷）、视力预后差和死亡率增加有关。
