Maculopathy and dengue.To the Editors: We thank Su and Chee (1) for their interest in our article, "Retinal Hemorrhages in 4 Patients with Dengue Fever" (2). We reported the findings of this small case series to highlight the presence of retinal hemorrhage as a manifestation of ophthalmic complication in patients with dengue fever. We wanted to describe characteristic clinical features (such as association of onset of visual symptoms with resolution of fever and nadir of thrombocytopenia Thrombocytopenia Definition Thrombocytopenia is an abnormal drop in the number of blood cells involved in forming blood clots. These cells are called platelets. ) and propose epidemiologic explanations for the sudden rise in the incidence of observed ocular complications of dengue fever in our population. Our article did not attempt to conclude that the retinal hemorrhages were responsible for the patients' visual symptoms, as suggested by Su et al. In fact, we stated that in all 4 patients "fundoscopic examination showed macular macular adjective Related to 1. A macule 2. The macula hemorrhages and exudative exudative of or pertaining to a process of exudation. exudative diathesis a disease of young pigs and chickens caused by a nutritional deficiency of vitamin E. Characterized by severe edema of the subcutaneous tissues. maculopathy." The range of dengue-related ophthalmic complication is still being investigated, and we agree with Su and Chee that other ophthalmic manifestations may occur in patients with dengue fever. In a retrospective observational case series involving 22 eyes of 13 patients with visual impairment from dengue infection, carried out in our hospital, Chan et al. (3) found evidence of retinal hemorrhage, macular edema, cotton wool spots Cotton wool spots are an abnormal finding on fundoscopic exam of the retina. They appear as puffy white patches on the retina. They are caused by damage to nerve fibers. The nerve fibers are damaged by swelling in the surface layer of the retina. , retinal vasculitis Vasculitis Definition Vasculitis refers to a varied group of disorders which all share a common underlying problem of inflammation of a blood vessel or blood vessels. The inflammation may affect any size blood vessel, anywhere in the body. , exudative retinal detachment, and anterior uveitis. Therefore, physicians and ophthalmologists should be aware of the possibilities of ophthalmic complications in the management of patients with dengue fever. References (1.) Su DH, Chee SP. Maculopathy in dengue fever. Emerg Infect Dis. 2006;12:707. (2.) Chlebicki MP, Ang B, Barkham T, Laude A. Retinal hemorrhages in 4 patients with dengue fever. Emerg Infect Dis. 2005; 11:770-2. (3.) Chan DP, Teoh SC, Tan CS, Nah GK, Rajagopalan R, Prabhakaragupta MK, et al. Ophthalmic complications of dengue. Emerg Infect Dis. 2006;12:285-9. Address for correspondence: Augustinus Laude, Tan Tock Seng Hospital The Tan Tock Seng Hospital (Abbreviation: TTSH; Chinese: 陈笃生医院; Malay: Hospital Tan Tock Seng , 11, Jalan Tan Tock Seng Tan Tock Seng (Simplified Chinese: 陈笃生; Traditional Chinese: 陳篤生; Pinyin: Chén Dǔshēng , Singapore 308433, Singapore; email: laude_augustinus@ttsh.com.sg Augustinus Laude, * Maciej Piotr Chlebicki, * Brenda Ang, * and Timothy Barkham * * Tan "rock Seng Hospital, Singapore |
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