title: A prospective case-control study to investigate retinal microvascular changes in acute dengue infection.
abstract: Dengue infection can affect the microcirculation by direct viral infection or activation of inflammation. We aimed to determine whether measured retinal vascular parameters were associated with acute dengue infection. Patients with acute dengue were recruited from Communicable Diseases Center, Singapore and age-gender-ethnicity matched healthy controls were selected from a population-based study. Retinal photographs were taken on recruitment and convalescence. A spectrum of quantitative retinal microvascular parameters (retinal vascular caliber, fractal dimension, tortuosity and branching angle) was measured using a semi-automated computer-based program. (Singapore I Vessel Assessment, version 3.0). We included 62 dengue patients and 127 controls. Dengue cases were more likely to have wider retinal arteriolar and venular calibers (158.3 μm vs 144.3 μm, p < 0.001; 227.7 μm vs 212.8 μm, p < 0.001; respectively), higher arteriolar and venular fractal dimensions (1.271 vs 1.249, p = 0.002; 1.268 vs. 1.230, p < 0.001, respectively), higher arteriolar and venular tortuosity (0.730 vs 0.546 [x10(4)], p < 0.001; 0.849 vs 0.658 [x10(4)], p < 0.001; respectively), compared to controls. Resolution of acute dengue coincided with decrease in retinal vascular calibers and venular fractal dimension. Dengue patients have altered microvascular network in the retina; these changes may reflect pathophysiological processes in the immune system.
authors.affiliation: National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.|Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Petrina
authors.initials: P
authors.lastname: Tan
authors.affiliation: Institute of Infectious Diseases and Epidemiology, Communicable Diseases Centre, Tan Tock Seng Hospital, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore.
authors.forename: David C
authors.initials: DC
authors.lastname: Lye
authors.affiliation: National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.
authors.forename: Tun Kuan
authors.initials: TK
authors.lastname: Yeo
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.|Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, National University of Singapore, Singapore.
authors.forename: Carol Y
authors.initials: CY
authors.lastname: Cheung
authors.affiliation: Institute of Infectious Diseases and Epidemiology, Communicable Diseases Centre, Tan Tock Seng Hospital, Singapore.
authors.forename: Tun-Linn
authors.initials: TL
authors.lastname: Thein
authors.affiliation: Institute of Infectious Diseases and Epidemiology, Communicable Diseases Centre, Tan Tock Seng Hospital, Singapore.
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Wong
authors.affiliation: National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.|Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Rupesh
authors.initials: R
authors.lastname: Agrawal
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.|Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, National University of Singapore, Singapore.
authors.forename: Ling-Jun
authors.initials: LJ
authors.lastname: Li
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.|Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, National University of Singapore, Singapore.
authors.forename: Tien-Yin
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Institute of Infectious Diseases and Epidemiology, Communicable Diseases Centre, Tan Tock Seng Hospital, Singapore.
authors.forename: Victor C
authors.initials: VC
authors.lastname: Gan
authors.affiliation: Institute of Infectious Diseases and Epidemiology, Communicable Diseases Centre, Tan Tock Seng Hospital, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore.|Saw Swee Hock School of Public Health, National University of Singapore.
authors.forename: Yee-Sin
authors.initials: YS
authors.lastname: Leo
authors.affiliation: National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.|Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.|Eagle Eye Center, Singapore.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Teoh
mesh_terms: D000208:Acute Disease; D000328:Adult; D001219:Aspartate Aminotransferases / Q000378:metabolism; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D003715:Dengue / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008833:Microcirculation; D055806:Microvessels / Q000503:physiopathology*; D011446:Prospective Studies; D012160:Retina / Q000503:physiopathology*
chemical_list: D006454:Hemoglobins; D003404:Creatinine; D001219:Aspartate Aminotransferases