To the Editor: A recent article byChlebicki et al (1) described 4 patientshospitalized for dengue fever whowere found to have retinal hemor-rhages. These patients reportedreduced visual acuity and metamor-phopsia, i.e., distorted visual imagesattributable to intrinsic retinal diseaseinvolving the macula; macular hemor-rhages and exudates were found onretinal examination. The authors con-cluded that the retinal hemorrhageswere responsible for the patients'visual symptoms.This conclusion is misleadingbecause retinal hemorrhages alonecause scotomas. Rather, the accumu-lation of subretinal fluid in the macu-la results in metamorphopsia andblurring of vision. In previous reportsof patients in whom macular changesdeveloped from dengue fever, somewere found to have macular hemor-rhages (2–4). In addition, clinicalexamination and investigation ofthese patients showed vasculopatho-logic changes in the macular regionthat affected the retinal and choroidalblood vessels (5), although the tissuesof the periphery tended to be spared.A fluorescein angiograph of the retinashowed knobby hyperfluorescence ofthe retinal arterioles with minimalleakage, as well as some spots of leak-age at the level of the retinal pigmentepithelium. An indocyanine greenangiograph showed diffuse hyperfluo-rescence of the choroid. These patho-logic changes in the macula were themost likely cause of the blurring ofvision in such patients, which hasbeen the case in our experience
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