Título

A CASE OF DENGUE MACULOPATHY WITH PROMPT RECOVERY AFTER TOPICAL MEDICATION

Objetivo

To report a rapid course of Dengue maculopathy recovery and the use of a topical nonsteroidal anti-inflamatory, since there is no standard treatment yet and also spontaneous recovery has been previously demonstrated.

Relato do Caso

On June 2020, during SARS-Cov-2 pandemic’s first wave, a 39 year-old female was admitted to our ophthalmologic emergency in a general hospital due to a suddenly and severely diminished sight bilaterally. Her visual symptoms started after a seven days history of fever, head, body and retro-orbital pains. The patient was negative for SARS-Cov-2, HIV and syphilis. Real-time PCR for dengue virus type 1 was positive and the diagnosis of dengue fever was confirmed. Her visual acuity was 20/400 in both eyes. Anterior segment examination was unremarkable and intraocular pressure was normal. The posterior segment examination showed arteriolar and venular sheating at macular region and severe bilateral macular edema. Scars from past coriorretinitis infections were seen on the right eye. Fluorescein angiogram markedly showed vascular wall staining on peri and justafoveal areas, mainly superiorly and arteriolar and venular occlusions. Spectral-domain optical coherence tomography (OCT) was performed and showed severe macular edema. Intravitreal steroid injection or topical nonsteroidal anti-inflamatory as options for treatment were discussed with the patient and we decided for the topic treatment with ketorolac trometamol 0.5%. Seven days later she reported a visual improvement, her visual acuity was 20/200 in both eyes, no evidence of vasculitis or macular edema. OCT proved a total remission of macular edema in right eye but a residual fluid in left macula.

Conclusão

The prognosis of dengue maculopathy is variable, with no proven effective treatment yet. The use of steroids has been reported in some cases with variable responses. There is no report on the relationship between the rapid course of maculopathy recovery and a topical nonsteroidal anti-inflamatory.