Clinical features, optical coherence tomography findings and treatment outcomes of post-fever retinitis

Author:

Sundar M Dheepak1ORCID,Chawla Rohan2ORCID,Balaji Akshaya1,Garg Itika3ORCID,Kalathil Reshmi1,Hasan Nasiq1,Vikas S J1,Kumar Atul1

Affiliation:

1. Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Science (AIIMS), New Delhi, India

2. Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Science (AIIMS), Ansari Nagar, Delhi 110029, India

3. Harvard Retinal Imaging Lab, Boston, MA, USA; Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA

Abstract

Objectives: To study the clinical features, optical coherence tomography (OCT) findings, treatment options and follow-up outcomes of post-fever retinitis (PFR). Subjects: A total of 19 eyes of 13 patients, diagnosed with PFR (retinitis following febrile episode) over 2 years were retrospectively studied. Methods: Documented history, baseline clinical features and systemic investigations performed for PFR were reviewed. Fundus findings, foveal architecture on swept-source OCT, the treatment options and the follow-up outcomes including best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were reviewed and analyzed. Results: Common fundus findings included whitish retinitis lesions (100%), macular star (95%, 18eyes), retinal flame-shaped hemorrhages (63%, 12 eyes), inflammatory retinal vessels (30%, 6 eyes), vitreous hemorrhage (one eye) and OCT findings included neuro-sensory detachment (79%, 15 eyes), intraretinal white dots (89.5%,17 eyes). The baseline median log MAR BCVA and CFT were 1.30 (interquartile range (IQR):0.8–1.8) and 423 microns (IQR:182–555). Overall, nine patients (12 eyes) received a combination of oral doxycycline and oral steroids and four patients (7 eyes) received a combination of oral doxycycline, oral steroid and intravitreal anti-vascular endothelial growth factor (IVA). Significant improvement was evident at 8 weeks in median BCVA (0.50, IQR: 0.3–0.8, p < 0.05) and median CFT (223 micron, IQR: 170–256, p < 0.05) though only 26% (5 eyes) attained BCVA > = 6/12. Conclusion: Our study puts forth certain characteristic fundus and OCT features of PFR. A combination of oral doxycycline and oral steroids as a treatment option showed improvement in BCVA and CFT. Additional IVA helps in faster visual recovery in patients presenting with severe macular edema at onset.

Publisher

SAGE Publications

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