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

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.

Epidemic retinitis with positive or negative Weil Felix Test - a comparative study and outcome with doxycycline.

“…Recently Sundar et al have reported a series of post-fever retinitis cases encouraging the use of anti-VEGF and oral steroids few days after oral doxycycline. 22 In contrast to their study, group A and B in our series (total 29 eyes of 23 patients) have effectively documented good visual outcome without the need of oral steroids or anti-VEGF as reported previously. 17 Even after considering the cases where retinitis lesions were within 1 disc diameter of center of fovea, visual outcome remained good, but the number of cases were small to derive a firm conclusion.…”

Epidemic retinitis - Factors associated with poor visual outcomes

“…Sunder et al . [ 2 ] found better results with anti-VEGFs in their study where their patients received anti-VEGFs along with doxycycline and steroids. But a comparative study, although with a small sample size did not find an additional benefit of anti-VEGFs in ER when treated with doxycycline and steroids or even with anti-VEGF monotherapy.…”

“…Epidemic retinitis (ER) or post-fever retinitis comprises a uveitic entity with a similar morphological pattern and course of the disease but different etiologies such as rickettsia, typhoid, dengue, chikungunya, and West Nile virus. [ 1 2 ] As a rule, there is a recent history of fever with or without joint pain and skin rash. In most cases, the diagnosis of the fever remains uncertain due to non-specific systemic manifestations or lack of gold-standard investigations.…”

Response to ‘Clinical features, optical coherence tomography findings and treatment outcomes of post-fever retinitis’

“…We find this outcome comparable or even better than the previous reports. [1][2][3][4] We are of opinion that most of the cases of epidemic retinitis can be treated with oral doxycycline and without any steroids or anti-VEGF agents. Topical steroids or topical non-steroidal anti-inflammatory drugs can be added depending on anterior segment inflammation.…”

“…We read the article ‘Clinical features, optical coherence tomography findings and treatment outcomes of post-fever retinitis’ published by Sunder and colleagues 1 with great interest. Authors have recommended the use of anti-vascular endothelial growth factor (anti-VEGF) as they found good outcome in their patients.…”