BACKGROUND: Dengue virus infection is on the rise and there is increasing number of ocular complications that are being reported. Most common ocular complications are macular edema, macular hemorrhages, and foveolitis. There are case reports on branch retinal vessel occlusions. Most of the ocular complications are attributed to the bleeding tendency and transudative process in dengue viral infection. This is a case report of ischemic central retinal vein occlusion (CRVO) concomitant with dengue fever.
CASE PRESENTATION: A 41 year old Malay female was admitted to medical ward and diagnosed to have "dengue fever with warning signs". On the day of admission she noted sudden onset of right eye blurring of vision. She presented to our clinic 1 week later. Ocular examination revealed right eye visual acuity of <20/1000 and ischaemic CRVO with macular edema. She had no other risk factors to develop retinal vein occlusion. She progressively developed proliferative retinopathy and received multiple laser therapy. There was no anterior segment neovascularization. However, her vision improved to only 20/400 despite of resolution of macular edema and new vessels elsewhere.
CONCLUSION: Dengue virus infection is known to cause thrombocytopenia which can result in hemorrhagic events. It can also cause procoagulant state which can result in thrombotic events secondary to immune reaction. Awareness among treating physicians of such ocular complication which can result in significant morbidity for patient is necessary.
Modern surgical interventions effectively treat macular holes (MHs) more than 90%. Current surgical treatment for MHs is pars plana vitrectomy with epiretinal membrane, internal limiting membrane (ILM) peeling, gas endotamponade, and prone posturing postoperatively. However, a small subset of MHs imposes challenges to surgeons and frustrations on patients. A narrative review was performed on the surgical treatment of challenging MHs including large and extra-large MHs, myopic MHs with or without retinal detachment, and chronic and refractory MHs. There are robust data supporting inverted ILM flap as the first-line treatment for large idiopathic MHs and certain secondary MHs including myopic MHs. In addition, several studies had shown that ILM flap manipulations in combination with surgical adjuncts increase surgical success, especially in difficult MHs. Even in eyes with limited ILM, surgical options included autologous retinal graft, human amniotic membrane, and creation of a distal ILM flap that can assist in MH closure even though the functional outcome may be affected by the MH chronicity. Despite relative success anatomically and visually after each technique, most techniques require a long-term study to analyze their safety profile and to establish any morphological changes of the MH plug in the closed MHs.