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. 2015 Nov 25:5:17183.
doi: 10.1038/srep17183.

A prospective case-control study to investigate retinal microvascular changes in acute dengue infection

Petrina Tan  1   2 , David C Lye  3   4 , Tun Kuan Yeo  1 , Carol Y Cheung  2   5 , Tun-Linn Thein  3 , Joshua G Wong  3 , Rupesh Agrawal  1   2 , Ling-Jun Li  2   5 , Tien-Yin Wong  2   5 , Victor C Gan  3 , Yee-Sin Leo  3   4   6 , Stephen C Teoh  1   2   7
Affiliations

A prospective case-control study to investigate retinal microvascular changes in acute dengue infection

Petrina Tan et al. Sci Rep. .

Abstract

Dengue infection can affect the microcirculation by direct viral infection or activation of inflammation. We aimed to determine whether measured retinal vascular parameters were associated with acute dengue infection. Patients with acute dengue were recruited from Communicable Diseases Center, Singapore and age-gender-ethnicity matched healthy controls were selected from a population-based study. Retinal photographs were taken on recruitment and convalescence. A spectrum of quantitative retinal microvascular parameters (retinal vascular caliber, fractal dimension, tortuosity and branching angle) was measured using a semi-automated computer-based program. (Singapore I Vessel Assessment, version 3.0). We included 62 dengue patients and 127 controls. Dengue cases were more likely to have wider retinal arteriolar and venular calibers (158.3 μm vs 144.3 μm, p < 0.001; 227.7 μm vs 212.8 μm, p < 0.001; respectively), higher arteriolar and venular fractal dimensions (1.271 vs 1.249, p = 0.002; 1.268 vs. 1.230, p < 0.001, respectively), higher arteriolar and venular tortuosity (0.730 vs 0.546 [x10(4)], p < 0.001; 0.849 vs 0.658 [x10(4)], p < 0.001; respectively), compared to controls. Resolution of acute dengue coincided with decrease in retinal vascular calibers and venular fractal dimension. Dengue patients have altered microvascular network in the retina; these changes may reflect pathophysiological processes in the immune system.

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Figures

Figure 1
Figure 1. Retinal fundus photograph assessed quantitatively by the Singapore I Vessel Assessment (SIVA) software (version 3.0, National University of Singapore, Singapore) in a dengue patient. Arterioles are in red and venules are in blue.
The measured area of retinal vascular parameters (caliber, fractal dimension, tortuosity and branching angle) was standardized as the region from 0.5 to 2.0 disc diameters away from the disc margin.
Figure 2
Figure 2. Example of a dengue patient (a) at acute dengue infection stage, and (b) at convalescence stage.
The retinal arteriolar caliber (127.0 vs. 138.8 μm) and venular caliber (205.1 vs. 228.7 μm) are decreased at covalescence stage.
See this image and copyright information in PMC

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