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Brief Report |

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

Miaoling Li, MD1; Xiongze Zhang, MD, PhD1; Yuying Ji, MD1; Baikang Ye, MD1; Feng Wen, MD, PhD1
[+] 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.
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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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Figure 1.
Case 1

A, Fundus photograph (top), infrared, and spectral-domain (SD) optical coherence tomography (OCT) of case 1 at baseline. Spectral-domain OCT reveals a hyperreflective band from the Henle fiber layer to the interdigitation zone (arrowheads). B, Fundus photograph (top), infrared, and SD-OCT 2 weeks later. Spectral-domain OCT demonstrates regression of the hyperreflective band, with associated thinning of the outer nuclear layer and disrupted underlying external limiting membrane, ellipsoid zone, and interdigitation zone (arrowheads). C, Fundus photograph (top), infrared, and SD-OCT at the last visit. Spectral-domain OCT shows complete restoration of the external limiting membrane and ellipsoid zone and discrete interdigitation zone (arrowheads). For A, B, and C, the images on the second row are of the right eye and those on the third row are of the left eye. Also in the second and third rows, infrared images are on the left and SD-OCT images on the right.

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Figure 2.
Case 2

A, Fundus photograph, autofluorescence, infrared, and spectral-domain (SD) optical coherence tomography (OCT) of case 2 at baseline. Spectral-domain OCT reveals hyperreflection extended from the Henle fiber layer to the ellipsoid zone and patchy dropout of the interdigitation zone (arrowheads). B, Fundus photograph, autofluorescence, infrared, and SD-OCT results 2 weeks later. Spectral-domain OCT demonstrates a decrease in size and intensity of the hyperreflective bands, accompanied by subtle outer nuclear layer thinning and disruption of the external limiting membrane, ellipsoid zone, and interdigitation zone (arrowheads). C, Fundus photograph, autofluorescence, infrared, and SD-OCT at the 6-month follow-up. Spectral-domain OCT shows a continued decrease in hyperreflection in addition to external limiting membrane and ellipsoid zone reconstruction; the interdigitation zone remains disrupted (arrowheads).

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