Persistent Retinal Deep Capillary Plexus Flow Impairment in Bilateral Acute Macular Neuroretinopathy Following Dengue Fever: A Case Report
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Yes
Purpose
To report a case of bilateral acute macular neuroretinopathy (AMN) secondary to dengue fever with persistent retinal deep capillary plexus (DCP) changes, highlighting multimodal imaging findings.
Methods
Retrospective case report with multimodal imaging analysis.
Results
A 38-year-old male presented with sudden bilateral central vision loss 3 days after dengue fever diagnosis (NS1-positive), during 2024 dengue epidemic in Brazil. Initial best-corrected visual acuity (BCVA) was 0.3 in the right eye (OD) and 0.1 in the left eye (OS). Fundoscopy revealed perifoveal hemorrhages and subtle foveal changes. HRA-OCT SPECTRALIS® multicolor reflectance imaging showed well-defined hyporeflective areas along the fovea and papillomacular bundle, better visualized on near-infrared reflectance mode. Spectral-domain OCT demonstrated hyperreflective lesions in the outer nuclear and outer plexiform layers. OCT angiography revealed focal flow attenuation exclusively in the DCP, while superficial and intermediate plexuses, as well as choriocapillaris, showed no focal abnormalities. After excluding other causes, oral prednisone (0.5mg/kg/day) was initiated at day 18. Despite OCT lesions resolution by day 25, final BCVA remained poor (OD: 0.4, OS: 0.2) at 6-month follow-up, with persistent DCP impairment and central scotomas in both eyes.
Conclusion
This case highlights AMN as a potential severe complication of dengue fever that can lead to persistent visual impairment. The exclusive DCP involvement, demonstrated by OCT-A, provides insights into AMN pathophysiology, suggesting that the primary vascular insult may occur in the deep retinal circulation rather than the choriocapillaris.
Conflict of interest
No
1
Last name
GUSMÃO
Initials of first name(s)
C.C.
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
São Paulo
Country
Brazil
2
Last name
HIRATA
Initials of first name(s)
C.E.
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
São Paulo
Country
Brazil
3
Last name
YAMAMOTO
Initials of first name(s)
J.H.
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
São Paulo
Country
Brazil
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