Pars Plana Vitrectomy for a Sub-Internal Limiting Membrane Hemorrhage and Vitreous Hemorrhage Secondary to Dengue Fever: A Case Report

Abstract

Although rare, dengue fever-associated ocular manifestations are a valid cause of visual impairment. Clinicians usually have a dilemma between vitrectomy and medical management if there is an associated vitreous hemorrhage. Vitrectomy has been rarely reported previously in the management of vitreous hemorrhage secondary to dengue fever. We report a case of a young adult who presented with bilateral vitreous hemorrhages. The diagnosis of dengue was confirmed by serology and a typical epidemiological context. The patient presented already having undergone yttrium aluminum garnet (YAG) laser hyaloidotomy for preretinal hemorrhage in the other eye, with a subsequent vitreous spread of the hemorrhage. Vitrectomy with internal limiting membrane (ILM) peeling was performed for the affected eye and the visual acuity was fully regained after a few weeks. Dengue fever can present with dense or sub-ILM hemorrhages. In our case, the vision quickly recovered after vitrectomy and ILM peeling. We, therefore, recommend early vitrectomy in cases with vitreous hemorrhage associated with sub-ILM involvement so as not to delay visual recovery.

Keywords: dengue fever; ilm peeling; pars plana vitrectomy; sub-internal limiting membrane haemorrhage; vitreous haemorrhage.

Figure 1. Color fundus photo at presentation.

The figure shows right preretinal hemorrhage involving the macula and left eye vitreous hemorrhage.

Figure 2. Left eye B-scan ultrasound image.

Note the hyperechogenic opacity in the posterior pole corresponding with the 100% reflectivity spike on A-scan.

Figure 3. Right eye preretinal hemorrhage after posterior YAG laser capsulotomy.

Note flesh blood migrating into the vitreous (arrow). YAG, yttrium aluminum garnet

Figure 4. Right eye shows cleared preretinal hemorrhage now located in the inferior quadrant vitreous (arrow). Left eye seen postoperatively.