Clinical observations and outcomes of dengue-associated retinopathy at a tertiary eye hospital in Nepal

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This virus can cause anterior uveitis to panuveitis. During acute phase, subconjunctival hemorrhage is a relatively common finding. Dengue associated maculopathy is one of the most common posterior segment findings that include both retinal hemorrhages, cotton wool spots, and macular edema. Objective To identify clinical features and visual outcome of dengue related retinopathy in patients at a tertiary eye hospital. Methodology A retrospective observational case series was conducted at the Tilganga Institute of Ophthalmology, Nepal focusing on all instances of dengue fever associated with retinal complications during the outbreak from August to October 2022. Results 36 patients were enrolled in the study, out of them, 18 (50%) were male and 18 (50%) were female. The average age ± sd of the patients was 9.0 ± 17 years (ranged 14 to 76 years). Thirty-five (97.2%) of the patients reported a decrease in vision and among them 25 (71.4%) experienced unilateral vision loss, while 10 (28.6%) exhibited bilateral involvement. Conclusion The ocular manifestations of dengue-associated eye disease range from vague symptoms to serious, perhaps blinding ocular involvement. Due to the recent increase in dengue outbreaks and the global spread of the dengue virus, all eye care providers should be aware of the many ocular signs of dengue-associated eye illness. ophthalmic manifestations dengue first presentation fever Figures Figure 1 Figure 2 Figure 3 Introduction Dengue fever is a mosquito-borne viral disease in human caused by four distinct dengue viruses (dengue 1–4). The primary vector for dengue is Aedes aegypti mosquito, found mostly in tropical and subtropical climates. Dengue fever represents the most rapidly spreading arboviral infection transmitted by Aedes aegypti mosquitoes, posing significant public health challenges for millions globally, particularly in the South-East Asia and Asia-Pacific regions as identified by the World Health Organization (WHO). 1 The clinical features of dengue are characterized by a fever that typically lasts around 7 days, although it may extend up to 19 days, indicating a prolonged course. A generalized erythematous skin flush that blanches upon pressure is a notable symptom, occurring more frequently than isolated rashes. 2 Out of the 2.5 billion individuals worldwide who are at risk of contracting dengue fever and its severe manifestations, namely dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), approximately 1.3 billion, or 52%, reside in South-East Asia. 1 However, recently dengue has also been found to affect the eye. It has a spectrum of ocular symptoms like mild blurring of vision, photophobia, ocular pain, redness, floaters, scotomas. On examination, patients had vitritis, disc edema, macular edema, retinitis, hemorrhages, exudates. Dengue has been endemic in Nepal since 2006, with a gradual increase in case numbers over the years. Notable epidemic outbreaks occurred in 2010, 2013, 2016, 2017, 2019, and 2022. The most significant outbreak took place in 2022, during which 42,504 confirmed cases and 51 confirmed fatalities were reported. 3 The underlying pathological mechanisms associated with ophthalmic symptoms of dengue remain inadequately understood. This research seeks to investigate the impact of dengue outbreaks on the retina. Additionally, it aims to elucidate the natural progression of the disease and its management, as such an investigation has not previously been conducted in Nepal. The findings will also serve to inform epidemiologists about the severity of the disease and raise awareness among stakeholders, thereby enhancing vigilance for potential future dengue outbreaks in Nepal. Methodology A retrospective observational case series was conducted at the Tilganga Institute of Ophthalmology, focusing on all instances of dengue fever associated with retinal complications during the outbreak from August 2022 to October 2022, with a follow-up period of no less than six weeks. Study included 70 eyes of 36 patients. Electronic medical record was used to collect data retrospectively. Ethical approval was obtained from the Tilganga Institute of Ophthalmology-Institutional Review Committee (Ref: 25/2022). The study included patients diagnosed by physician with dengue fever who presented with various ophthalmic symptoms, such as diminution of vision, photophobia, ocular pain, redness, and floaters. Each patient underwent examination at the outpatient department of the Tilganga Institute of Ophthalmology. Assessments included visual acuity tests, anterior segment evaluations using a slit lamp biomicroscope, and retinal examinations utilizing a 90 D lens on a pharmacologically dilated fundus. Additional investigations, such as macular optical coherence tomography, optical coherence tomography angiography, fundus fluorescein angiography, and Humphrey’s visual field analysis, were also taken. Patients who were either not diagnosed with dengue by a physician or showed involvement of the anterior segment were excluded from the study. Using electronic medical record of the hospital, data was entered and cleaned using Microsoft Excel. The cleaned dataset was subsequently imported into IBM SPSS Version 20 for analysis. Mean, number percentages were calculated as a descriptive measure. Various visual representations, including tables and bar charts, were prepared as required. For before after comparison of vision in two categories, McNemar’s test was used. P value less than 0.05 was considered as statically significant. Results Table 1 Age distribution of the cases Age group (Years) Number Percentage 14–18 3 8.3 19–29 10 27.8 30–39 7 19.4 40–49 7 19.4 50–59 5 13.9 60 and above 4 11.1 Total 36 100.0 Total of 36 patients were included in this study. Out of them, 18 (50%) were male and 18 (50%) were female. The age of the patients ranged between 14–76 years of age with the mean ± sd value of 39.0 ± 17 years. Table 1 illustrates the age distribution among a sample of 36 individuals, detailing both the absolute numbers and the percentage representation of each age group within the total sample. The age group of 19–29 years represented the largest proportion of cases, comprising 27.8% of the total. This was followed by the age groups of 30–39 years and 40–49 years, which together accounted for 19.4% of all cases. Figure 1 illustrates the ocular symptoms observed in the patients. A total of 35 patients, accounting for 88.6% of the cases, reported a decrease in vision. Of these 35 patients, 25 experienced unilateral vision loss, while 10 exhibited bilateral involvement. Among the 35 patients experiencing vision loss, 2 cases were associated with scotoma, while another 2 cases were associated with floaters. Out of the total patients, 26 of them had systemic symptoms in the form of fever. All the patients with systemic symptoms had fever of more than 100°F with the maximum of 105°F lasting from 2 days to 3 weeks maximum. Figure 2 shows the duration between the onset of systemic and ocular symptoms. More than half of patients (57.69%) developed ocular manifestations within 7 days of fever, 36.76% patients developed ocular symptoms between 1–2 weeks while only 11.53% patients developed ocular symptoms after 2 weeks of fever onset. Fever duration was as short as 2 days to a maximum of 3 weeks. This bar chart compares the visual acuity (BCVA) of 47 individuals before (BCVA at the time of presentation represented in blue color) and after six months (BCVA at 6 months follow up after treatment, represented in red color). The data shows significant improvement in vision over time. 61.7% of participants had visual acuity in the range of 6/6 to 6/9 before treatment, which increased to 93.6% after six months, Pre-treatment, 8.5% of participants were in < 6/9 to 6/18 category, compared to 2.1% after six months. Initially, 21.3% fell into < 6/18 to 6/60 group, while only 2.1% remained here at the six-months. 4.3% were in < 6/60 to 3/60 category pre-treatment, but none remained after six months. Pre-treatment, 4.3% had very poor vision < 3/60, compared to just 2.1% after six months. Overall, this chart shows significant improved in vision after six months of treatment. Table 2 Statistical analysis of comparison of BCVA pre and post 6 months (eyes) Vision BCVA Before UCVA (6 months) p value Number Percentage Number Percentage < 6/18 to PL 14 29.8 3 6.4 < 0.001 6/6 to 6/18 33 70.2 44 93.6 Total 47 100.0 47 100.0 *McNemar's test The comparison of the best corrected visual acuity of patients at the time of presentation and at the six-month follow-up revealed a statistically significant difference, with a p-value of less than 0.001, as depicted in Table 2 . Table 3 Ocular signs (number of eyes = 70) SIGNS Number (Eyes) Percentage Macular edema 11 15.7 Macular hemorrhage 11 15.7 Retinal hemorrhage 8 11.4 Vaso-occlusive diseases 7 10.0 Maculopathy 6 8.6 Foveolitis 5 7.1 Wet AMD 2 2.9 Disc edema 2 2.9 AMNR 2 2.9 This data presents the distribution of ocular signs, showing the number of eyes affected and the corresponding percentage. The most frequent ocular signs were present on the macular region. Macular edema (15.71%) and macular hemorrhage (15.71%) along with retinal hemorrhage (11.43%) were the most common ocular findings as examined by 90D lens and slit lamp examination on a dilated pupil. Vaso-occlusive disease like CRVO, CRAO and BRVO were found in 10% of the patients. Maculopathy and foveolitis were also found in 8.57% and 7.14% respectively. Wet age-related macular degeneration (AMD), disc edema and acute macular neuroretinopathy (AMNR) were also found in few of the cases. Discussion A seldom studied component of dengue expanded illness is its ocular manifestations. Even though it was once believed that ocular problems were uncommon, more and more cases are being recorded annually. 4 Cotton-wool spots, disc edema, anterior uveitis, vitreous hemorrhage, retinal hemorrhages, conjunctival petechial hemorrhages (commonest), and maculopathy are among the documented aftereffects of dengue fever on the eyes. 4 It has been observed that platelet counts below 50,000/mL predispose people to ocular hemorrhages. 5 On the other hand, our investigation revealed that subconjunctival hemorrhage, with a platelet count > 50,000/ml, is the most frequently occurring initial presenting characteristic in otherwise undetected dengue patients. A case of a young female presenting with bilateral mild vitreous hemorrhage following seven days of dengue fever was reported by Kapoor et al. 6 Numerous other studies have also documented vitreous bleeding. 7 In each of the patients, the presentation occurred more than 20 days following the diagnosis of dengue fever. On the other hand, in our investigation, the initial symptom of every patient with dengue-related vitreous hemorrhage was blurred vision. They underwent additional testing to rule out visual impairment and discovered they had a vitreous hemorrhage. Upon examining the cause of the vitreous hemorrhage in each of these patients, it was noted that the platelet count was less than 70,000/µl. After being sent to the medical department for additional assessment, the individuals received a dengue fever diagnosis. 8 There are comparatively few cases of dengue-associated cranial neuropathies documented, particularly those affecting the abducens nerve. 9 In two of the dengue cases that remained untreated up until that point, their investigation documented abducens nerve cranial neuropathy as the initial presenting feature. Therefore, when assessing adult instances of cranial neuropathies, a high degree of suspicion is necessary; a dengue diagnosis should be kept in mind, especially in patients originating from dengue endemic zones. A comprehensive history was taken for their study, which helped and directed us to the patient's final diagnosis. Immune-mediated pathogenesis is thought to be responsible for neuro-ophthalmic consequences, despite being unknown. 10 This study also highlighted the fact that dengue-related ocular diseases, like conjunctivitis and sub-conjunctival hemorrhage, often recover on their own without the need for medical intervention and with favorable visual outcomes. However, in situations like posterior segment symptoms and uveitis, immediate care is necessary. Based on the degree of ocular involvement, topical or oral steroids may be administered. If detected and treated promptly, dengue ophthalmic problems have a good visual result. Otherwise, even after the clinical clearance of dengue ocular problems, some patients may have persistent scotomas. The exact cause of dengue-related ocular problem is unclear; however, it is thought to be related to immune-mediated processes, most likely dengue serotyping. Most likely, there is a direct correlation between the immunopathogenesis of dengue fever and the pathogenesis of these ocular manifestations. When cells are infected with the dengue virus, vascular endothelium undergoes inflammatory alterations that can cause vascular leakage, hemorrhage, and ischemia. Dengue fever should always be kept as a differential diagnosis in cases comparable to dengue, and ophthalmologists and other medical professionals should be sufficiently aware of the disease's ocular symptoms. Limitations Study was a single centered study and follow up period was only 6 weeks. Residual vision loss after 6 weeks could not be trace. Conclusion Although less frequently reported in medical texts and publications, dengue-related ocular problems are becoming more common in South-East Asia. The usual patient is a young, immunocompetent person who appears with paracentral scotoma or visual blurring five to seven days after fever onset, which corresponds with the lowest point of thrombocytopenia. The symptoms of an inflammatory maculopathy, which include focal chorioretinitis and macular hemorrhage with or without macular oedema, are usually seen in the eyes. The illness is typically self-limiting and goes away on its own with quick structural resolution and improved visual acuity as a result. Following the initial episode of inflammatory chorioretinitis, patients with maculopathy may experience dry perifoveal pigmentary alterations, and functional residual scotomas may last longer than a year following the disease's systemic remission. Recommendation : Multicentered study with longer follow up period is required to find ocular manifestations and its associated complications in dengue fever. Declarations Ethics approval and consent to participate: Ethical approval was obtained from the Tilganga Institute of Ophthalmology-Institutional Review Committee (Ref: 25/2022). Since, this is retrospective study and data was taken from electronic medical record of the hospital, so patients consent was not taken. Consent for publication: Since, this is retrospective study and data was taken from electronic medical record of the hospital, so patients consent was not taken for publication. Availability of data and materials: Data will be available on request. Competing interests: No Funding: No Authors' contributions: SN Name Role Contribution 1 Eli Pradhan First Author Led the conception and design of the study, Provided overall guidance and supervision, Approved the final version of the manuscript. 2 Rachni Gurung Author Contributed to data acquisition and initial analysis, Assisted in drafting the manuscript, Reviewed and approved the final version. 3 Sadichhya Shrestha Author Involved in data collection and interpretation, Contributed to manuscript revisions, Approved the final version of the manuscript. 4 Bivek Wagle Author Participated in data acquisition and analysis, Assisted in manuscript preparation, Approved the final version of the manuscript. 5 Sushma Duwal Author Analysis, Assisted in revising the manuscript 6 Jyoti Bastola Paudel Author Involved in data acquisition and analysis, Contributed to manuscript drafting, Approved the final version of the manuscript. 7 Sanjita Sharma Author Participated in data collection and analysis, Assisted in manuscript preparation 8 Smita Shrestha Author Contributed to data acquisition and interpretation, Assisted in revising the manuscript 9 Raba Thapa Author Involved in analysis, Contributed to manuscript drafting and revisions, Approved the final version of the manuscript. 10 Anu Manandhar Author Participated in data acquisition and interpretation; finalize the manuscript, Analysis 11 Manish Poudel Corresponding Author Corresponding Author; Conducted the statistical analysis; Managed the submission process and correspondence; Assisted in drafting and revising the manuscript. Acknowledgments : First and foremost, we are immensely thankful to our Associate Professor Dr. Eli Pradhan, head of department of medical retina of Tilganga Institute of Ophthalmology, for providing us with this opportunity. We are also thankful to all staffs of our investigation department. Our work would not be worthwhile, if we fail to pay gratitude to all the participants of this study for their kind cooperation, without which this study would not have been possible. Authors' information (optional): Eli Pradhan 1 , Rachni Gurung 1 , Sadichhya Shrestha 1 , Bivek Wagle 2 , Sushma Duwal 1 , Jyoti Bastola Paudel 3 , Sanjita Sharma 1 , Smita Shrestha 1 , Raba Thapa 1 , Anu Manandhar 1 , and Manish Poudel 1 1. Tilganga Institute of ophthalmology, Gaushala, Nepal 2. The Ohio State University, Ohio, USA 3. Nepal Police Hospital, Maharajgunj, Nepal outbreak from September 2022 to November 2022, with a follow-up period of no less than six weeks. Ethical approval was obtained from the Tilganga Institute of Ophthalmology-Institutional Review Committee (Ref: 25/2022). References World Health Organization, Regional Office for South-East Asia. Comprehensive Guideline for Prevention and Control of Dengue and Dengue Haemorrhagic Fever. Revised and Expanded Edition. New Delhi: WHO Regional Office for South-East Asia. 2011. Available from: https://iris.who.int/handle/10665/204894 . Accessed 2024 Oct 8. Kularatne S, Gawarammana I, Kumarasiri P. Epidemiology, clinical features, laboratory investigations and early diagnosis of dengue fever in adults: a descriptive study in Sri Lanka. Southeast Asian J Trop Med Public Health. 2005;36(3). Rijal K, Adhikari B, Ghimire B, et al. Epidemiology of dengue virus infections in Nepal, 2006–2019. Infect Dis Poverty. 2021;10. 10.1186/s40249-021-00837-0 . Yip V, Sanjay S, Koh YT. Ophthalmic complications of dengue fever: a systematic review. Ophthalmol Ther. 2012;1. 10.1007/s40123-012-0002-z . Carod Artal F. Neurological manifestations of dengue viral infection. Res Rep Trop Med. 2014;2014:95. 10.2147/RRTM.S55372 . Kapoor H, Bhai S, John M, Xavier J. Ocular manifestations of dengue fever in an East Indian epidemic. Can J Ophthalmol. 2007;41:741–6. 10.3129/i06-069 . Nainiwal S, Garg S, Prakash G, Nainiwal N. Bilateral vitreous haemorrhage associated with dengue fever. Eye (Lond). 2005;19:1012–3. 10.1038/sj.eye.6701704 . Mishra A, Tripathi A, Agrawal M, Bhirud A, Gupta S, Parihar J. Ophthalmic manifestations as the first presenting feature in dengue fever: a 10-year study. Romanian J Ophthalmol. 2024;68:31–6. 10.22336/rjo.2024.07 . Chan DP, Teoh SC, Tan CS, et al. Ophthalmic complications of dengue. Emerg Infect Dis. 2006;12(2):285. 10.3201/eid1202.050274 . Shivanthan M, Ratnayake E, Wijesiriwardena B, Somaratna K, Gamagedara L. Paralytic squint due to abducens nerve palsy: a rare consequence of dengue fever. BMC Infect Dis. 2012;12:156. 10.1186/1471-2334-12-156 . Additional Declarations No competing interests reported. Supplementary Files EthicalApprovalletter.pdf Datasent.xlsx Cite Share Download PDF Status: Published Journal Publication published 15 Jul, 2025 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 20 May, 2025 Reviews received at journal 19 May, 2025 Reviewers agreed at journal 19 May, 2025 Reviewers agreed at journal 18 May, 2025 Reviews received at journal 17 May, 2025 Reviews received at journal 20 Apr, 2025 Reviewers agreed at journal 20 Mar, 2025 Reviewers agreed at journal 19 Mar, 2025 Reviewers invited by journal 19 Mar, 2025 Editor assigned by journal 19 Mar, 2025 Editor invited by journal 18 Mar, 2025 Submission checks completed at journal 17 Mar, 2025 First submitted to journal 17 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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mosquito-borne viral disease in human caused by four distinct dengue viruses (dengue 1\u0026ndash;4). The primary vector for dengue is Aedes aegypti mosquito, found mostly in tropical and subtropical climates. Dengue fever represents the most rapidly spreading arboviral infection transmitted by Aedes aegypti mosquitoes, posing significant public health challenges for millions globally, particularly in the South-East Asia and Asia-Pacific regions as identified by the World Health Organization (WHO).\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The clinical features of dengue are characterized by a fever that typically lasts around 7 days, although it may extend up to 19 days, indicating a prolonged course. A generalized erythematous skin flush that blanches upon pressure is a notable symptom, occurring more frequently than isolated rashes.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Out of the 2.5\u0026nbsp;billion individuals worldwide who are at risk of contracting dengue fever and its severe manifestations, namely dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), approximately 1.3\u0026nbsp;billion, or 52%, reside in South-East Asia.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e However, recently dengue has also been found to affect the eye. It has a spectrum of ocular symptoms like mild blurring of vision, photophobia, ocular pain, redness, floaters, scotomas. On examination, patients had vitritis, disc edema, macular edema, retinitis, hemorrhages, exudates.\u003c/p\u003e \u003cp\u003eDengue has been endemic in Nepal since 2006, with a gradual increase in case numbers over the years. Notable epidemic outbreaks occurred in 2010, 2013, 2016, 2017, 2019, and 2022. The most significant outbreak took place in 2022, during which 42,504 confirmed cases and 51 confirmed fatalities were reported.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The underlying pathological mechanisms associated with ophthalmic symptoms of dengue remain inadequately understood. This research seeks to investigate the impact of dengue outbreaks on the retina. Additionally, it aims to elucidate the natural progression of the disease and its management, as such an investigation has not previously been conducted in Nepal. The findings will also serve to inform epidemiologists about the severity of the disease and raise awareness among stakeholders, thereby enhancing vigilance for potential future dengue outbreaks in Nepal.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eA retrospective observational case series was conducted at the Tilganga Institute of Ophthalmology, focusing on all instances of dengue fever associated with retinal complications during the outbreak from August 2022 to October 2022, with a follow-up period of no less than six weeks. Study included 70 eyes of 36 patients. Electronic medical record was used to collect data retrospectively. Ethical approval was obtained from the Tilganga Institute of Ophthalmology-Institutional Review Committee (Ref: 25/2022). The study included patients diagnosed by physician with dengue fever who presented with various ophthalmic symptoms, such as diminution of vision, photophobia, ocular pain, redness, and floaters. Each patient underwent examination at the outpatient department of the Tilganga Institute of Ophthalmology. Assessments included visual acuity tests, anterior segment evaluations using a slit lamp biomicroscope, and retinal examinations utilizing a 90 D lens on a pharmacologically dilated fundus.\u003c/p\u003e \u003cp\u003eAdditional investigations, such as macular optical coherence tomography, optical coherence tomography angiography, fundus fluorescein angiography, and Humphrey\u0026rsquo;s visual field analysis, were also taken. Patients who were either not diagnosed with dengue by a physician or showed involvement of the anterior segment were excluded from the study.\u003c/p\u003e \u003cp\u003eUsing electronic medical record of the hospital, data was entered and cleaned using Microsoft Excel. The cleaned dataset was subsequently imported into IBM SPSS Version 20 for analysis. Mean, number percentages were calculated as a descriptive measure. Various visual representations, including tables and bar charts, were prepared as required. For before after comparison of vision in two categories, McNemar\u0026rsquo;s test was used. P value less than 0.05 was considered as statically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAge distribution of the cases\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group (Years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u0026ndash;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTotal of 36 patients were included in this study. Out of them, 18 (50%) were male and 18 (50%) were female. The age of the patients ranged between 14\u0026ndash;76 years of age with the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;sd value of 39.0\u0026thinsp;\u0026plusmn;\u0026thinsp;17 years. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the age distribution among a sample of 36 individuals, detailing both the absolute numbers and the percentage representation of each age group within the total sample. The age group of 19\u0026ndash;29 years represented the largest proportion of cases, comprising 27.8% of the total. This was followed by the age groups of 30\u0026ndash;39 years and 40\u0026ndash;49 years, which together accounted for 19.4% of all cases.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the ocular symptoms observed in the patients. A total of 35 patients, accounting for 88.6% of the cases, reported a decrease in vision. Of these 35 patients, 25 experienced unilateral vision loss, while 10 exhibited bilateral involvement. Among the 35 patients experiencing vision loss, 2 cases were associated with scotoma, while another 2 cases were associated with floaters.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOut of the total patients, 26 of them had systemic symptoms in the form of fever. All the patients with systemic symptoms had fever of more than 100\u0026deg;F with the maximum of 105\u0026deg;F lasting from 2 days to 3 weeks maximum. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the duration between the onset of systemic and ocular symptoms. More than half of patients (57.69%) developed ocular manifestations within 7 days of fever, 36.76% patients developed ocular symptoms between 1\u0026ndash;2 weeks while only 11.53% patients developed ocular symptoms after 2 weeks of fever onset. Fever duration was as short as 2 days to a maximum of 3 weeks.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThis bar chart compares the visual acuity (BCVA) of 47 individuals before (BCVA at the time of presentation represented in blue color) and after six months (BCVA at 6 months follow up after treatment, represented in red color). The data shows significant improvement in vision over time. 61.7% of participants had visual acuity in the range of 6/6 to 6/9 before treatment, which increased to 93.6% after six months, Pre-treatment, 8.5% of participants were in \u0026lt;\u0026thinsp;6/9 to 6/18 category, compared to 2.1% after six months. Initially, 21.3% fell into \u0026lt;\u0026thinsp;6/18 to 6/60 group, while only 2.1% remained here at the six-months. 4.3% were in \u0026lt;\u0026thinsp;6/60 to 3/60 category pre-treatment, but none remained after six months. Pre-treatment, 4.3% had very poor vision\u0026thinsp;\u0026lt;\u0026thinsp;3/60, compared to just 2.1% after six months. Overall, this chart shows significant improved in vision after six months of treatment.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStatistical analysis of comparison of BCVA pre and post 6 months (eyes)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBCVA Before\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eUCVA (6 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6/18 to PL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6/6 to 6/18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003cp\u003e*McNemar's test\u003c/p\u003e\n\u003cp\u003eThe comparison of the best corrected visual acuity of patients at the time of presentation and at the six-month follow-up revealed a statistically significant difference, with a p-value of less than 0.001, as depicted in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOcular signs (number of eyes\u0026thinsp;=\u0026thinsp;70)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSIGNS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber (Eyes)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacular edema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacular hemorrhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetinal hemorrhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaso-occlusive diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaculopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFoveolitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWet AMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisc edema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis data presents the distribution of ocular signs, showing the number of eyes affected and the corresponding percentage.\u003c/p\u003e \u003cp\u003eThe most frequent ocular signs were present on the macular region. Macular edema (15.71%) and macular hemorrhage (15.71%) along with retinal hemorrhage (11.43%) were the most common ocular findings as examined by 90D lens and slit lamp examination on a dilated pupil. Vaso-occlusive disease like CRVO, CRAO and BRVO were found in 10% of the patients. Maculopathy and foveolitis were also found in 8.57% and 7.14% respectively. Wet age-related macular degeneration (AMD), disc edema and acute macular neuroretinopathy (AMNR) were also found in few of the cases.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eA seldom studied component of dengue expanded illness is its ocular manifestations. Even though it was once believed that ocular problems were uncommon, more and more cases are being recorded annually.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCotton-wool spots, disc edema, anterior uveitis, vitreous hemorrhage, retinal hemorrhages, conjunctival petechial hemorrhages (commonest), and maculopathy are among the documented aftereffects of dengue fever on the eyes.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e It has been observed that platelet counts below 50,000/mL predispose people to ocular hemorrhages.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e On the other hand, our investigation revealed that subconjunctival hemorrhage, with a platelet count\u0026thinsp;\u0026gt;\u0026thinsp;50,000/ml, is the most frequently occurring initial presenting characteristic in otherwise undetected dengue patients.\u003c/p\u003e \u003cp\u003eA case of a young female presenting with bilateral mild vitreous hemorrhage following seven days of dengue fever was reported by Kapoor et al.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Numerous other studies have also documented vitreous bleeding.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e In each of the patients, the presentation occurred more than 20 days following the diagnosis of dengue fever. On the other hand, in our investigation, the initial symptom of every patient with dengue-related vitreous hemorrhage was blurred vision. They underwent additional testing to rule out visual impairment and discovered they had a vitreous hemorrhage. Upon examining the cause of the vitreous hemorrhage in each of these patients, it was noted that the platelet count was less than 70,000/\u0026micro;l. After being sent to the medical department for additional assessment, the individuals received a dengue fever diagnosis.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThere are comparatively few cases of dengue-associated cranial neuropathies documented, particularly those affecting the abducens nerve.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e In two of the dengue cases that remained untreated up until that point, their investigation documented abducens nerve cranial neuropathy as the initial presenting feature. Therefore, when assessing adult instances of cranial neuropathies, a high degree of suspicion is necessary; a dengue diagnosis should be kept in mind, especially in patients originating from dengue endemic zones. A comprehensive history was taken for their study, which helped and directed us to the patient's final diagnosis. Immune-mediated pathogenesis is thought to be responsible for neuro-ophthalmic consequences, despite being unknown.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study also highlighted the fact that dengue-related ocular diseases, like conjunctivitis and sub-conjunctival hemorrhage, often recover on their own without the need for medical intervention and with favorable visual outcomes. However, in situations like posterior segment symptoms and uveitis, immediate care is necessary. Based on the degree of ocular involvement, topical or oral steroids may be administered. If detected and treated promptly, dengue ophthalmic problems have a good visual result. Otherwise, even after the clinical clearance of dengue ocular problems, some patients may have persistent scotomas.\u003c/p\u003e \u003cp\u003eThe exact cause of dengue-related ocular problem is unclear; however, it is thought to be related to immune-mediated processes, most likely dengue serotyping. Most likely, there is a direct correlation between the immunopathogenesis of dengue fever and the pathogenesis of these ocular manifestations. When cells are infected with the dengue virus, vascular endothelium undergoes inflammatory alterations that can cause vascular leakage, hemorrhage, and ischemia. Dengue fever should always be kept as a differential diagnosis in cases comparable to dengue, and ophthalmologists and other medical professionals should be sufficiently aware of the disease's ocular symptoms.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitations\u003c/strong\u003e \u003cp\u003eStudy was a single centered study and follow up period was only 6 weeks. Residual vision loss after 6 weeks could not be trace.\u003c/p\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAlthough less frequently reported in medical texts and publications, dengue-related ocular problems are becoming more common in South-East Asia. The usual patient is a young, immunocompetent person who appears with paracentral scotoma or visual blurring five to seven days after fever onset, which corresponds with the lowest point of thrombocytopenia. The symptoms of an inflammatory maculopathy, which include focal chorioretinitis and macular hemorrhage with or without macular oedema, are usually seen in the eyes.\u003c/p\u003e \u003cp\u003eThe illness is typically self-limiting and goes away on its own with quick structural resolution and improved visual acuity as a result.\u003c/p\u003e \u003cp\u003eFollowing the initial episode of inflammatory chorioretinitis, patients with maculopathy may experience dry perifoveal pigmentary alterations, and functional residual scotomas may last longer than a year following the disease's systemic remission.\u003c/p\u003e\n\u003cdiv class=\"Heading\"\u003e\u003cb\u003eRecommendation\u003c/b\u003e:\u003c/div\u003e \u003cp\u003eMulticentered study with longer follow up period is required to find ocular manifestations and its associated complications in dengue fever.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Tilganga Institute of Ophthalmology-Institutional Review Committee (Ref: 25/2022). Since, this is retrospective study and data was taken from electronic medical record of the hospital, so patients consent was not taken.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince, this is retrospective study and data was taken from electronic medical record of the hospital, so patients consent was not taken for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData will be available on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo\u003cbr\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6.01266%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4557%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eName\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.557%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRole\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.9747%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContribution\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6.01266%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4557%;\"\u003e\n \u003cp\u003eEli Pradhan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.557%;\"\u003e\n \u003cp\u003eFirst Author\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.9747%;\"\u003e\n \u003cp\u003eLed the conception and design of the study, Provided overall guidance and supervision, Approved the final version of the manuscript.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6.01266%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4557%;\"\u003e\n \u003cp\u003eRachni Gurung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.557%;\"\u003e\n \u003cp\u003eAuthor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.9747%;\"\u003e\n \u003cp\u003eContributed to data acquisition and initial analysis, Assisted in drafting the manuscript, Reviewed and approved the final version.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6.01266%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4557%;\"\u003e\n \u003cp\u003eSadichhya Shrestha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.557%;\"\u003e\n \u003cp\u003eAuthor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.9747%;\"\u003e\n \u003cp\u003eInvolved in data collection and interpretation, Contributed to manuscript revisions, Approved the final version of the manuscript.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6.01266%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4557%;\"\u003e\n \u003cp\u003eBivek Wagle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.557%;\"\u003e\n \u003cp\u003eAuthor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.9747%;\"\u003e\n \u003cp\u003eParticipated in data acquisition and analysis, Assisted in manuscript preparation, Approved the final version of the manuscript.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6.01266%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4557%;\"\u003e\n \u003cp\u003eSushma Duwal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.557%;\"\u003e\n \u003cp\u003eAuthor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.9747%;\"\u003e\n \u003cp\u003e\u0026nbsp;Analysis, Assisted in revising the manuscript\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6.01266%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4557%;\"\u003e\n \u003cp\u003eJyoti Bastola Paudel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.557%;\"\u003e\n \u003cp\u003eAuthor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.9747%;\"\u003e\n \u003cp\u003eInvolved in data acquisition and analysis, Contributed to manuscript drafting, Approved the final version of the manuscript.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6.01266%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4557%;\"\u003e\n \u003cp\u003eSanjita Sharma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.557%;\"\u003e\n \u003cp\u003eAuthor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.9747%;\"\u003e\n \u003cp\u003eParticipated in data collection and analysis, Assisted in manuscript preparation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6.01266%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4557%;\"\u003e\n \u003cp\u003eSmita Shrestha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.557%;\"\u003e\n \u003cp\u003eAuthor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.9747%;\"\u003e\n \u003cp\u003eContributed to data acquisition and interpretation, Assisted in revising the manuscript\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6.01266%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4557%;\"\u003e\n \u003cp\u003eRaba Thapa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.557%;\"\u003e\n \u003cp\u003eAuthor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.9747%;\"\u003e\n \u003cp\u003eInvolved in analysis, Contributed to manuscript drafting and revisions, Approved the final version of the manuscript.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6.01266%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4557%;\"\u003e\n \u003cp\u003eAnu Manandhar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.557%;\"\u003e\n \u003cp\u003eAuthor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.9747%;\"\u003e\n \u003cp\u003eParticipated in data acquisition and interpretation; finalize the manuscript, Analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6.01266%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4557%;\"\u003e\n \u003cp\u003eManish Poudel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.557%;\"\u003e\n \u003cp\u003eCorresponding Author\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.9747%;\"\u003e\n \u003cp\u003eCorresponding Author; Conducted the statistical analysis; Managed the submission process and correspondence; Assisted in drafting and revising the manuscript.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;First and foremost, we are immensely thankful to our Associate Professor Dr. Eli Pradhan, head of department of medical retina of Tilganga Institute of Ophthalmology, for providing us with this opportunity. We are also thankful to all staffs of our investigation department. Our work would not be worthwhile, if we fail to pay gratitude to all the participants of this study for their kind cooperation, without which this study would not have been possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information (optional):\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEli Pradhan\u003csup\u003e1\u003c/sup\u003e, Rachni Gurung\u003csup\u003e1\u003c/sup\u003e, Sadichhya Shrestha\u003csup\u003e1\u003c/sup\u003e, Bivek Wagle\u003csup\u003e2\u003c/sup\u003e, Sushma Duwal\u003csup\u003e1\u003c/sup\u003e, Jyoti Bastola Paudel\u003csup\u003e3\u003c/sup\u003e, Sanjita Sharma\u003csup\u003e1\u003c/sup\u003e, Smita Shrestha\u003csup\u003e1\u003c/sup\u003e, Raba Thapa\u003csup\u003e1\u003c/sup\u003e, Anu Manandhar\u003csup\u003e1\u003c/sup\u003e, and Manish Poudel\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e1. Tilganga Institute of ophthalmology, Gaushala, Nepal\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. The Ohio State University, Ohio, USA\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. Nepal Police Hospital, Maharajgunj, Nepal\u0026nbsp;\u003c/p\u003e\u003cp\u003eoutbreak from September 2022 to November 2022, with a follow-up period of no less than six weeks.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Tilganga Institute of Ophthalmology-Institutional Review Committee (Ref: 25/2022).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization, Regional Office for South-East Asia. Comprehensive Guideline for Prevention and Control of Dengue and Dengue Haemorrhagic Fever. Revised and Expanded Edition. New Delhi: WHO Regional Office for South-East Asia. 2011. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/handle/10665/204894\u003c/span\u003e\u003cspan address=\"https://iris.who.int/handle/10665/204894\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 2024 Oct 8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKularatne S, Gawarammana I, Kumarasiri P. Epidemiology, clinical features, laboratory investigations and early diagnosis of dengue fever in adults: a descriptive study in Sri Lanka. Southeast Asian J Trop Med Public Health. 2005;36(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRijal K, Adhikari B, Ghimire B, et al. Epidemiology of dengue virus infections in Nepal, 2006\u0026ndash;2019. 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Res Rep Trop Med. 2014;2014:95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/RRTM.S55372\u003c/span\u003e\u003cspan address=\"10.2147/RRTM.S55372\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKapoor H, Bhai S, John M, Xavier J. Ocular manifestations of dengue fever in an East Indian epidemic. Can J Ophthalmol. 2007;41:741\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3129/i06-069\u003c/span\u003e\u003cspan address=\"10.3129/i06-069\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNainiwal S, Garg S, Prakash G, Nainiwal N. Bilateral vitreous haemorrhage associated with dengue fever. 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BMC Infect Dis. 2012;12:156. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1471-2334-12-156\u003c/span\u003e\u003cspan address=\"10.1186/1471-2334-12-156\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"ophthalmic manifestations, dengue, first presentation, fever","lastPublishedDoi":"10.21203/rs.3.rs-6122588/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6122588/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinically, the dengue virus can cause hemorrhagic complications or ocular inflammation. This virus can cause anterior uveitis to panuveitis. During acute phase, subconjunctival hemorrhage is a relatively common finding. Dengue associated maculopathy is one of the most common posterior segment findings that include both retinal hemorrhages, cotton wool spots, and macular edema.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo identify clinical features and visual outcome of dengue related retinopathy in patients at a tertiary eye hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective observational case series was conducted at the Tilganga Institute of Ophthalmology, Nepal focusing on all instances of dengue fever associated with retinal complications during the outbreak from August to October 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e36 patients were enrolled in the study, out of them, 18 (50%) were male and 18 (50%) were female. The average age ± sd of the patients was 9.0 ± 17 years (ranged 14 to 76 years). Thirty-five (97.2%) of the patients reported a decrease in vision and among them 25 (71.4%) experienced unilateral vision loss, while 10 (28.6%) exhibited bilateral involvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ocular manifestations of dengue-associated eye disease range from vague symptoms to serious, perhaps blinding ocular involvement. Due to the recent increase in dengue outbreaks and the global spread of the dengue virus, all eye care providers should be aware of the many ocular signs of dengue-associated eye illness.\u003c/p\u003e","manuscriptTitle":"Clinical observations and outcomes of dengue-associated retinopathy at a tertiary eye hospital in Nepal","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-24 15:48:38","doi":"10.21203/rs.3.rs-6122588/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-20T09:22:02+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-19T11:26:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"161713591842656956192247870122119926725","date":"2025-05-19T06:26:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"262360137506594740773031975763284042210","date":"2025-05-18T14:55:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-17T18:11:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-20T16:47:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336745403942011539645438480844350308965","date":"2025-03-20T16:56:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180505621336980268806448669932143389276","date":"2025-03-19T09:29:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-19T06:42:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-19T06:41:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-18T06:16:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-17T15:35:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2025-03-17T15:34:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ed42ce08-537a-4344-97cb-f163b8338113","owner":[],"postedDate":"March 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-21T16:09:25+00:00","versionOfRecord":{"articleIdentity":"rs-6122588","link":"https://doi.org/10.1186/s12886-025-04215-4","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2025-07-15 16:05:40","publishedOnDateReadable":"July 15th, 2025"},"versionCreatedAt":"2025-03-24 15:48:38","video":"","vorDoi":"10.1186/s12886-025-04215-4","vorDoiUrl":"https://doi.org/10.1186/s12886-025-04215-4","workflowStages":[]},"version":"v1","identity":"rs-6122588","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6122588","identity":"rs-6122588","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}