Multi-color imaging in a unilateral central retinal artery occlusion following dengue fever: A case report and literature review

Abstract

Background: Dengue fever is associated with various sight-threatening ocular manifestations, some of which can occur several months after fever. These include subconjunctival hemorrhage, vitreous hemorrhage, retinal hemorrhage, cotton wool spots, central and branch retinal artery occlusion, central scotoma, papilledema, optic neuropathy, retinal vasculitis, retinitis, retinal pigment epithelium mottling, foveolitis, choroidal effusion, exudative retinal detachment, anterior uveitis, endogenous endophthalmitis, and panophthalmitis. Herein, we report a patient with unilateral central retinal artery occlusion (CRAO) and raised dengue immunoglobulin G (IgG) titers who underwent serial multimodal imaging with fundus photography, spectral domain optical coherence tomography (SD-OCT), optical coherence tomography angiography (OCTA), and multi-color imaging (MCI). Furthermore, we reviewed recent publications highlighting different eye diseases and the role of MCI in their diagnosis and serial monitoring.
 Case presentation: A 53-year-old Asian Indian woman complained of blurring of vision in the right eye (OD) two months after a bout of fever. Her best-corrected distance visual acuity was finger counting close to the face in the OD and 20/40 in the left eye. CRAO of the OD was diagnosed. Systemic investigations were normal except for elevated dengue IgG levels. Optical coherence tomography and fluorescein angiography confirmed this diagnosis. MCI and SD-OCT using Spectralis™ performed before and after treatment with oral steroids demonstrated improvement. MCI served as a noninvasive ancillary tool for monitoring the CRAO. In addition to the case report, we summarize articles pertaining to MCI published during the years 2018–2022. The list is not exhaustive but highlights salient features of different retinal and choroidal disorders evaluated using MCI. Our summary highlights the role of MCI in the diagnosis and serial monitoring of eye diseases.
 Conclusions: A diagnosis of post-dengue fever retinal artery occlusion should be made after ruling out other causes of retinal artery vascular occlusion. We demonstrated retinal changes using serial imaging. MCI can be a useful tool, along with SD-OCT, to monitor clinical improvement. Optometrists can follow up patients with retinal vascular occlusions using noninvasive methods.