title: Choroidal neovascularization induced by immunogenic alteration of the retinal pigment epithelium in dengue Fever.
abstract: OBJECTIVE
  To report the first case of choroidal neovascularization (CNV) secondary to dengue fever.
  
  
  METHODS
  A 54-year-old female was referred to our department with blurred vision and metamorphopsia in her left eye. Two weeks earlier, she had presented all of the classic symptoms of dengue fever including a positive serology. Her best-corrected visual acuity (BCVA) was 20/150 in the left eye. She underwent a fundus examination, fluorescein angiography (FA) and spectral domain optical coherence tomography.
  
  
  RESULTS
  All findings were consistent with CNV secondary to dengue fever. FA revealed a classic CNV associated with focal retinal pigment epithelium (RPE) destruction and detachment. Three consecutive monthly injections of intravitreal ranibizumab resulted in functional and anatomical improvement for as long as 6 months with a BCVA of 20/25. However, CNV recurred 2 years later, again with an improvement after ranibizumab therapy, but with persistence of a fibrovascular RPE detachment, highlighting the pathomechanism of a classic CNV formation.
  
  
  CONCLUSIONS
  Maculopathy in dengue fever may be followed by CNV as a result of the immunologic alteration of the RPE. Physicians should be aware of this manifestation to be able to initiate adequate treatment with excellent functional and anatomical results.
authors.affiliation: Retina Section, Department of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Veloso
authors.affiliation: Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
authors.forename: Ursula
authors.initials: U
authors.lastname: Schmidt-Erfurth
authors.affiliation: Retina Section, Department of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Márcio B
authors.initials: MB
authors.lastname: Nehemy
keywords: Antiangiogenic therapy; Choroidal neovascularization; Complement activation; Dengue maculopathy