Abstract
Purpose: To investigate the prevalence of fundus and macular optical coherence tomography (OCT) findings, and the spectrum of dengue-related fundus presentation in a Malaysian tertiary hospital. The associations between platelet count and haematocrit level with fundus and macular OCT findings were also investigated.
 Design: Cross-sectional study.
 Methods: The study was conducted at Hospital Raja Permaisuri Bainun, Ipoh, from June to August 2015. Patients who consented to participate underwent a comprehensive ocular examination. Examination included a best-corrected distance (6 m) and near visual acuities, standard black-on-white Amsler chart testing, pupillary light reflex, fundus examination, followed by dilated fundus photographs and OCT of the macula.
 Results: A total of 134 patients were included in the study. The prevalence of positive fundus finding and macular OCT finding was 35% (95% confidence interval [CI]: 27%, 43%) and 13% (95% CI: 8%, 19%), respectively; 62 eyes of 47 patients had positive fundus findings, whereas 30 eyes of 18 patients had positive macular OCT findings. Scotoma (p < 0.001), near vision disturbance (p = 0.04), and abnormal Amsler findings (p < 0.001) were significantly associated with presence of macular OCT findings compared to absence of macular OCT findings. In the total of 268 eyes, the two most common fundus findings were vessel tortuosity (53 [20%]) and yellow subretinal dot (28 [10%]). Out of 30 eyes, diffuse retinal thickening was the most frequent OCT finding (22 [73%]), followed by 4 (13%) with foveolitis, 3 (10%) with cystoid macular oedema and 1 (3%) with submacular fluid. Platelet count and haematocrit were not associated with abnormal fundus or macular OCT manifestation in patients suffering from dengue fever.
 Conclusion: Our study revealed that the prevalence of clinical fundus and macular OCT findings among dengue inpatients was higher when compared to other countries, especially during dengue outbreaks. Furthermore, the spectrum of fundus and macular OCT findings in our population can be varied.
Highlights
Dengue virus (DEN) is a common Aedes-borne flavivirus of humans in Malaysia
Our study revealed that the prevalence of clinical fundus and macular optical coherence tomography (OCT) findings among dengue inpatients was higher when compared to other countries, especially during dengue outbreaks
All dengue patients who were admitted with a clinical diagnosis of dengue fever[15,16], age ≥ 12 years, able to sit for ocular examination and investigation, and a presence of clear media allowing fundus examination were included in the study
Summary
Dengue virus (DEN) is a common Aedes-borne flavivirus of humans in Malaysia. There are four antigenically related serotypes present in Malaysia, which include DEN-1, 2, 3, and 4.1 The World Health Organization (WHO) estimates 50 to 100 million dengue infections occurring annually across 100 countries including Asia, Pacific regions, Americas, Africa, and Caribbean.[1]Dengue is endemic in Malaysia, and the incidence has more than doubled from 2013 to 2014, with an increment over 150%.2 The cumulative number of reported dengue cases in 2015 alone had reached almost 120,000.2 Perak is the fourth largest state in Malaysia, and the cumulative incidence of dengue was 8,157 cases from January to October 2015. Dengue virus (DEN) is a common Aedes-borne flavivirus of humans in Malaysia. There are four antigenically related serotypes present in Malaysia, which include DEN-1, 2, 3, and 4.1 The World Health Organization (WHO) estimates 50 to 100 million dengue infections occurring annually across 100 countries including Asia, Pacific regions, Americas, Africa, and Caribbean.[1]. Dengue is endemic in Malaysia, and the incidence has more than doubled from 2013 to 2014, with an increment over 150%.2. The cumulative number of reported dengue cases in 2015 alone had reached almost 120,000.2 Perak is the fourth largest state in Malaysia, and the cumulative incidence of dengue was 8,157 cases from January to October 2015. In comparison to 2014, it was half of the numbers reported within the same period.[3] Our study hospital, Hospital Raja Permaisuri Bainun, is the referral hospital in Perak
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