Transcript Fundus Examination : Left Eye - Springer Static Content Server

Chikungunya Retinitis
Dr Padmamalini Mahendradas
Head, Uveitis and Ocular Immunology
Narayana Nethralaya
Bangalore.
Ocular History
45 years female
• presented first on 12/2006
• decreased vision in the OS since 15 days
• eye pain since 4 days
• Chikungunya fever 4 weeks back
Examination
OD
OS
• EOM
Normal
Normal
• Vision
6/60, N18
CF 1 mtr
• Anterior segment
Normal
RAPD
• IOP
10 mmHg
10 mmHg
Fundus Examination: Right Eye
Fundus and red-free photograph of the right eye shows multiple areas of retinal
opacification suggestive of retinitis with retinal hemorrhages
Fundus Examination : Left Eye
Fundus photograph shows vitreous haze 1+, mild hyperemic disc with
multifocal retinitis and hemorrhages in the posterior pole of the left eye and
red-free photograph also showing the presence of retinitis and hemorrhages in the
left eye.
Investigations
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Hb 10.5 gm% , TC & DC – within normal limits
ESR-20 mm /hr
Malarial Parasite -absent
Dengue rapid test - negative
Leptospirosis - negative
Chest x-ray - normal
TPHA- non reactive
Toxoplasma IgM & IgG - negative
HIV I &II - negative
Mantoux - negative
Chikungunya IgM - positive
Fundus Fluorescein Angiography
Early Phase
Capillary non perfusion
corresponding to the area of
retinal whitening with vascular
leakage in the posterior pole
Hyperfluorescence with capillary
non perfusion in the macular
area
Fundus Fluorescein Angiography
Late Phase
Hyperfluorescence due to
vascular leakage
Leakage from the optic disc
with widespread vasculitis
and staining of retinal
infiltrates
Clinical Diagnosis
• Bilateral Multifocal Retinitis due to Viral
etiology (? Chikungunya ) was made
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Treatment
Systemic acyclovir 800 mg 5 times a day was started
with systemic corticosteroids (oral prednisolone 60 mg/day)
 with Chikungunya positive Ig M titer and after ruling out other
infections
 Acyclovir was stopped
 Oral prednisolone 60mg/day was continued for one week and
then it was tapered over a period of 8 weeks.
 H2 receptor blocker (Ranitidine 150 mg bd) & calcium
supplements for 8 weeks
Follow up: after 6 Months
Resolved retinitis with pigment
epithelial changes at the foveal
area
VA 6/9, N6.
Temporal pallor of the disc
with pigment epithelial changes
VA CF 1 meter ,<N36
Discussion
• Chikungunya retinitis may morphologically mimic
herpetic viral retinitis
• the history of fever, joint pains, and skin rash before the
onset of visual symptoms is helpful in the diagnosis,
particularly in endemic regions.
Mahendradas P, Ranganna SK, Shetty R, Balu R, et al. Ocular Manifestations
Associated with Chikungunya. Ophthalmology, 2007; 115:287-291.
Discussion
• Ocular manifestations may be due to inflammatory
response to Chikungunya virus or direct ocular
involvement by the virus.
• We were able to obtain serologic evidence in our case
and molecular diagnostic test such as RT- PCR could
not be done due to non availability of the test in 2006.
Discussion
• Strong clinical association was established based on the
temporal association between the systemic manifestations,
ocular manifestations & positive serology allowing us to
make a diagnosis of Chikungunya retinitis.
• Patients with retinitis showed improvement with
corticosteroids
Conclusion
• Chikungunya can cause ocular manifestation such as
retinitis.
• Ophthalmologists need to be aware of these features
in geographic regions Asia, Africa and French
reunion where the chikungunya fever is prevalent.