Retinal changes in visceral leishmaniasis by retinal photography

Abstract

Background: In visceral leishmaniasis (VL), retinal changes have previously been noted but not described in detail and their clinical and pathological significance are unknown. A prospective observational study was undertaken in Mymensingh, Bangladesh aiming to describe in detail visible changes in the retina in unselected patients with VL.

Methods: Patients underwent assessment of visual function, indirect and direct ophthalmoscopy and portable retinal photography. The photographs were assessed by masked observers including assessment for vessel tortuosity using a semi-automated system.

Results: 30 patients with VL were enrolled, of whom 6 (20%) had abnormalities. These included 5 with focal retinal whitening, 2 with cotton wool spots, 2 with haemorrhages, as well as increased vessel tortuosity. Visual function was preserved.

Conclusions: These changes suggest a previously unrecognized retinal vasculopathy. An inflammatory aetiology is plausible such as a subclinical retinal vasculitis, possibly with altered local microvascular autoregulation, and warrants further investigation.

Figure 1

Composite retinal photographs of patients with visceral leishmaniasis. Details of retinal findings are listed in Table 2. A Patient 1 right eye, B Patient 1 left eye, C patient 3 right eye, D patient 4 right eye, E patient 2 right eye and F patient 2 left eye.