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Brief Report
November 2015

Acute Macular Neuroretinopathy in Dengue Fever: Short-term Prospectively Followed Up Case Series

Author Affiliations
  • 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
JAMA Ophthalmol. 2015;133(11):1329-1333. doi:10.1001/jamaophthalmol.2015.2687
Abstract

Importance  The incidence of dengue fever (DF) increases every year. Macular complications of patients with DF may be more common than many ophthalmologists realize. During a DF outbreak in South China in 2014, we observed acute macular neuroretinopathy associated with DF.

Observations  Among 9 patients (17 eyes) with maculopathy post-DF, 5 patients (55.6%) (9 eyes) manifesting acute macular neuroretinopathy were recruited from August 1, 2014, to September 30, 2014, with a 6-month ophthalmic follow-up. Infrared reflectance imaging demonstrated localized areas of hyporeflection in the macula. Spectral-domain (SD) optical coherence tomography (OCT) scanning through these areas revealed hyperreflection in the photoreceptor layer and disruption of its normal reflective structures. Subsequent SD-OCT demonstrated that the hyperreflection of the photoreceptor layer regressed gradually, followed by thinning of the outer nuclear layer. The external limiting membrane and ellipsoid zone became continuous; however, the interdigitation zone was not restored. The scotomas persisted in all 5 patients (9 eyes) by the last visit. All 5 patients (9 eyes) in this case series were complicated with classic dengue maculopathy signs, such as intraretinal hemorrhage and exudation, which were completely resolved during the follow-up.

Conclusions and Relevance  These data suggest that acute macular neuroretinopathy is a major manifestation of dengue maculopathy, with persistent scotomas through at least 6 months.

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