• Users Online: 579
  • Home
  • Print this page
  • Email this page
Home Current issue Ahead of print Search About us Abstracting and Indexing Editorial board Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
PHOTO ESSAY
Year : 2015  |  Volume : 10  |  Issue : 4  |  Page : 491-492

Demonstration of retinal Micro-emboli in a case of malaria retinopathy by fundus fluorescein angiography


Sri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Nungambakkam, Chennai, Tamil Nadu, India

Date of Submission15-Nov-2014
Date of Acceptance10-Jan-2015
Date of Web Publication18-Feb-2016

Correspondence Address:
Aditya Verma
Sri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, No. 18, College Road, Nungambakkam, Chennai - 600 006, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2008-322X.176914

Rights and Permissions

How to cite this article:
Verma A, Shaikh S. Demonstration of retinal Micro-emboli in a case of malaria retinopathy by fundus fluorescein angiography. J Ophthalmic Vis Res 2015;10:491-2

How to cite this URL:
Verma A, Shaikh S. Demonstration of retinal Micro-emboli in a case of malaria retinopathy by fundus fluorescein angiography. J Ophthalmic Vis Res [serial online] 2015 [cited 2020 Jan 18];10:491-2. Available from: http://www.jovr.org/text.asp?2015/10/4/491/176914


  Presentation Top


A 17-year-old female patient with a history of malaria fever, caused by Plasmodium falciparum, presented with sudden decrease of vision in her left eye 10 days after the onset of fever to an Ophthalmologist elsewhere. The patient was referred to our center one month later. On examination, vision was 20/20 and 20/1200 in the right and left eyes, respectively. The ophthalmic examination of the right eye was unremarkable. The left eye had relative afferent papillary defect and fundus examination revealed retinal hemorrhages, superior branch retinal vein occlusion, and neovascularization. Fluorescein angiography (FA) revealed venous obliteration along the superior arcade, with large areas of capillary dropout in the superior and temporal periphery [Figure 1]. The areas of interest were intravascular micro-emboli (coiled structures) along the superior veins (arrows) on FA [Figure 2]. The resultant venous obstruction and capillary dropout areas were noted in the corresponding peripheral retina which was drained by these vessels, as observed on FA [Figure 3]. The superior vein obliteration was immediately distal to the micro-embolus (at the bifurcation).
Figure 1. Mid-phase fundus fluorescein angiography of the left eye shows venous obliteration along the superior arcade, with large areas of capillary dropout in the superior and temporal periphery. Neovascular fronds are seen along the superior arcade retinal veins; blocked fluorescence is noted along the inferior arcade due to subhyaloid hemorrhage.

Click here to view
Figure 2. The area of interest from [Figure 1] shows intravascular micro-emboli (coiled structures) along the superior veins (yellow arrows) seen as hyperfluorescent intravascular lesions.

Click here to view
Figure 3. Superior and temporal quadrants of the left eye on late-phase fluorescein angiography show venous obstruction and capillary dropout areas in the corresponding peripheral retina drained by these vessels as shown in Figure 2. The superior vein obliteration is seen immediately distal to the micro-embolus (at the bifurcation, yellow arrows).

Click here to view



  Discussion Top


Microvascular occlusion has been postulated to be the primary pathogenic mechanism in cerebral malaria and malaria retinopathy.[1] Occlusion usually results from cohesiveness of infected and non-infected erythrocytes.[2] Histologically, sequestration of infected and non-deformable erythrocytes has been observed in previous studies. The in vivo appearance of micro-emboli in the retinal vessels infected with malaria has not been reported before. FA images presented herein characteristically show intra-vascular coiled structures with resultant peripheral capillary dropout. We postulate that the coiled structures seen in retinal vessels may represent an aggregation of infected erythrocytes, which may get stained with FFA due to sluggish blood flow. Although the origin and significance of these coiled structures are unknown, their location corresponded well to the vessel obliteration, implying intravascular micro-emboli. The extensive new vessel formation early in the course of the disease appears to be due to the amount of ischemia related to extensive vascular occlusion due to multiple micro-emboli in the retinal circulation.

 
  References Top

1.
Maude RJ, Dondorp AM, Abu Sayeed A, Day NP, White NJ, Beare NA. The eye in cerebral malaria: What can it teach us? Trans R Soc Trop Med Hyg 2009;103:661-664.  Back to cited text no. 1
    
2.
Dondorp AM, Kager PA, Vreeken J, White NJ. Abnormal blood flow and red blood cell deformability in severe malaria. Parasitol Today 2000;16:228-232.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Presentation
Discussion
References
Article Figures

 Article Access Statistics
    Viewed791    
    Printed7    
    Emailed0    
    PDF Downloaded105    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]