June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Subclinical changes on hand-held optical coherence tomography in apparently malaria retinopathy-negative patients with cerebral malaria
Author Affiliations & Notes
  • Zhanhan Tu
    Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
  • Jack Gormley
    University of Liverpool, Leeds, United Kingdom
  • Viral Sheth
    Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
  • Frank A Proudlock
    Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
  • Karl Seydel
    University of Michigan, Ann Arbor, Michigan, United States
  • Terrie Taylor
    University of Michigan, Ann Arbor, Michigan, United States
  • Gerald Msukwa
    College of Medicine, Blantyre, Malawi
  • Nicholas V. Beare
    University of Liverpool, Leeds, United Kingdom
  • Simon P Harding
    University of Liverpool, Leeds, United Kingdom
  • Irene Gottlob
    Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
  • Footnotes
    Commercial Relationships   Zhanhan Tu, None; Jack Gormley, None; Viral Sheth, None; Frank Proudlock, None; Karl Seydel, None; Terrie Taylor, None; Gerald Msukwa, None; Nicholas V. Beare, None; Simon Harding, None; Irene Gottlob, None
  • Footnotes
    Support  MRC grants (MR/J004189/1 and MRC/N004566/1), Ulverscroft Foundation, Michigan State University, Blantyre Malaria Project, Foundation for the Prevention of Blindness UK.
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5135. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to Subscribers Only
      Sign In or Create an Account ×
    • Get Citation

      Zhanhan Tu, Jack Gormley, Viral Sheth, Frank A Proudlock, Karl Seydel, Terrie Taylor, Gerald Msukwa, Nicholas V. Beare, Simon P Harding, Irene Gottlob; Subclinical changes on hand-held optical coherence tomography in apparently malaria retinopathy-negative patients with cerebral malaria. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5135.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
Abstract

Purpose : There are approximately 214 million malaria cases annually. Of the African children with cerebral malaria (CM) 15% die and 30% have long-term neurological sequelae. Diagnosis of CM can be difficult. Retinal changes closely reflect cerebral changes, thus helping CM diagnosis. Clinical signs of malarial retinopathy (MR) (retinal whitening; vessel discoloration; hemorrhages; papilledema) not only help detect CM but also predict severity. However, one-third of CM patients are MR-negative by funduscopic examination. Also, on autopsy, 30% of patients dying of coma and positive for malaria parasitemia end up having alternative diagnosis. Therefore it is important to detect subtle retinal changes in funduscopy negative patients. This study used hand-held optical coherence tomography (HH-OCT) for the first time for this purpose.

Methods : Five funduscopy-negative patients with CM were recruited from the Queen Elizabeth Central Hospital, Blantyre, Malawi. All underwent full medical assessments, dilated funduscopy, photography, fluorescein angiography and HH-OCT scans (7 x 7 x 2mm volume for each A scan, 1000 A scans per B scan, 140 or 210 B scans) for fovea and optic nerve on admission once they had been stabilised after treatment. OCT findings were compared with those observed in retinopathy positive CM patients (n=26) and local age-matched children were used as controls.

Results : HH-OCT showed that all 5 retinopathy negative patients had the changes typically observed in MR. Four had hyper-reflective vessel walls with hypo-reflective lumina, 3 had hyper-reflective vessels with hyper-reflective lumina and one had numerous hyper-reflective capillaries. The hyper-reflective vessels and capillaries are consistent with parasitized erythrocytes segregating on the vessel walls, as described histologically.

Conclusions : HH-OCT can detect subclinical retinal changes in patients with CM. OCT may increase the accuracy of CM diagnosis in funduscopy negative patients, enabling specific therapeutic intervention. In the future, studies of HH-OCT in a larger number of retinopathy negative patients and correlation with autopsy findings are necessary.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×