OSLI Retina

January 2021

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50 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ I M A G E S I N O P H T H A L M O L O G Y ■ Retinopathy Secondary to Uncomplicated Plasmodium vivax Malaria Srikanta Kumar Padhy, MD; Suman Sahu, MD; Vishal Govindahari, MD ABSTRACT: To report a case of bilateral ma- larial retinopathy secondary to uncomplicated Plasmodium vivax malaria. A 45-year-old male patient presented with sudden onset of dimi- nution of vision both eyes and was treated for P. vivax malaria 1 week before the ocular symp- toms. Dilated fundus examination revealed mul- tiple intraretinal (dot-blot, flame shaped) hem- orrhages, cotton-wool spots, and areas of retinal whitening predominantly involving the posterior pole both eyes, with features being more severe in left eye. Optical coherence tomography revealed bilateral subfoveal neurosensory detachments. Retinopathy is typically rare in the settings of P. vivax malaria, albeit commonly seen in patients with cerebral malaria (Plasmodium falciparum). [Ophthalmic Surg Lasers Imaging Retina. 2021;52:50-51.] INTRODUCTION A 45-year-old male presented to us with the com- plaints of sudden onset painless diminution of vision both eyes (left more than right) for more than 10 days. Medical records revealed that 2 weeks prior to the onset of ocular symptoms, he was treated with intra- muscular injection Arteether (3 days) for high-grade fever secondary to Plasmodium vivax malaria (based on microscopy and rapid diagnostic test positivity). Blood reports denoted a normal haemoglobin, total platelet count, blood sugar, coagulation profile, and serum glucose-6-phosphate dehydrogenase (G6PD) enzyme levels. Blood pressure at presentation was 122/78 mm Hg and there was no history of hyperten- sion. Best-corrected visual acuity at presentation was 20/20p in the right eye (OD) and counting finger at 1m in the left eye (OS). Intraocular pressures were 16 mm Hg in both eyes (OU), with unremarkable anterior segments under slit-lamp. Dilated fundus examina- tion revealed multiple intraretinal hemorrhages (dot- blot, flame shaped), cotton-wool spots, and areas of retinal whitening predominantly involving the pos- terior pole OU (Figures 1a and 1b). Retinal whitening was more pronounced in OS surrounding fovea along with segmentation of blood columns (cattle trucking of veins) in the superior arcade vessels. (Figure 1b, inset) Optical coherence tomography passing through fovea showed inner retinal hyper reflectivity and thickening with subfoveal neurosensory detachment OU. (Figures 1c and 1d) Based on clinical and inves- tigational finding a diagnosis of both eyes malarial retinopathy was made and patient was planned for OU intravitreal triamcinolone injection. From Vitreoretinal Services, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha (SKP, SS); and Vitreoretinal Services, Pushpagiri Vitreo Retina Institute, Hyderabad, Telangana (VG). Originally submitted April 18, 2020. Revision received November 3, 2020. Accepted for publication November 20, 2020. The authors report no relevant financial disclosures. Address correspondence to Vishal Govindahari, MD, Pushpagiri Vitreo Retina Institute, Plot No. 241, Uma Plaza, 9, W Marredpally Rd., Secunderabad, Telan- gana, India 500026; email: vishal.govindhari@gmail.com. doi: 10.3928/23258160-20201223-10

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