Bilateral Premacular Subhyaloid Hemorrhage in Dengue Fever

A 13-year-old girl presented to the ophthalmology clinic complaining of painless decrease in vision in both eyes from two weeks before presentation. Visual loss had been accompanied by fever, muscle pain, chills and headache; however the patient had become afebrile four days before referral. Ocular examination revealed best corrected visual acuity (BCVA) of counting fingers in the right eye (OD) and 3/200 in her left eye (OS). The anterior segment was normal in both eyes. Fundus examination revealed multiple superficial retinal hemorrhages, Roth spots, and large subhyaloid hemorrhages in both eyes (Figures 1 and 2). The patient was referred to an internist for systemic evaluation which disclosed multiple petechial hemorrhages on her extremities. Blood counts showed leukopenia (3,200 cells/ ml), thrombocytopenia (22,000 cells/ml) and hemoglobin level of 11 g/dL. IgM for Dengue by enzyme-linked immunosorbent assay was positive confirming a diagnosis of Dengue hemorrhagic fever (One step rapid card test, SD BIOLINE Dengue Duo, Dengue NS1 Ag + Ab Combo kit, Standard Diagnostic Inc., Kyonggi-Do, South Korea). The patient was treated with packed cell/ platelet transfusions and re-examined after 3 weeks. BCVA had slightly improved to 20/200 OD (Figure 3) and 6/200 OS. As she was still medically unstable, a choice of observation or Nd:YAG laser hyaloidotomy was offered. Nd:YAG hyaloidotomy was performed on the left eye with the following specifications: spot size, 50 to 100 μm; power, 300 mW to 500 mW; and duration, 100 ms to 300 ms. Two bursts were applied and hyaloidotomy was performed on the stretched posterior hyaloid surface (Fig. 4). The patient was revisited after 1 week. BCVA at this time interval was 20/400 OD and 20/30 OS (the treated eye). At final follow-up, 3 months after initial presentation, the patient had stable visual acuity (Figures 5 and 6).