- Email: [email protected]
Author reply
Ophthalmology Volume 116, Number 1, January 2009 rabbits after intravitreal administration of a solution or a PLGA microsphere formulation. Toxicol Sci 1999;52:101– 6. 5. Malhotra BK, Brundage RC, Lemaire M, Sawchuk RJ. Modeling the route of administration-based enhancement in the brain delivery of EAB 515, studied by microdialysis. J Drug Target 1997;4:277– 88.
Dengue Optic Neuropathy Dear Editor: We read with interest the article by Laurence et al1 reporting 3 cases of optic neuritis attributed to dengue fever. The authors have erroneously stated that only 3 cases of optic neuritis associated with dengue virus infection have been reported in the literature and that “we report the first small series of patients with optic neuritis attributed to dengue fever in the literature.” Optic nerve involvement in dengue fever is indeed rare, but reported cases seem to be on the rise in recent years. To the best of our knowledge, Wen et al2 were the first to report a case of optic neuritis in their series of 24 cases of ocular involvement after dengue fever. Another retrospective case series of 41 patients with dengue maculopathy also included 8 eyes with disc edema and 10 eyes with disc hyperemia, presumably signs of optic nerve involvement.3 More recently, our series of 3 cases of dengue fever-associated optic neuropathy was published online in March 2008.4 Despite the high prevalence of dengue fever in tropical and subtropical areas of the world and the proposed tropism of Arboviruses for the central nervous system, dengue fever rarely presents with central nervous manifestations.1– 4 Neuromyelitis optica has been reported after dengue fever, albeit rarely.5 None of our cases had neurologic symptoms.4 We agree with Laurence et al1 that ocular involvement in dengue fever patients may occasionally result in profound permanent visual impairment. One of the cases reported by us lost light perception in the presenting eye despite treatment with a course of intravenous methylprednisolone.4 SRINIVASAN SANJAY, MRCS(EDIN) AJEET M. WAGLE, FRCS(EDIN) KAH-GUAN AU EONG, FRCS(EDIN) Singapore References 1. Beral L, Merle H, David T. Ocular complications of dengue fever. Ophthalmology 2008;115:1100 –1. 2. Wen KH, Sheu MM, Chung CB, et al. The ocular fundus findings in dengue fever [Article in Chinese] Gaoxiong Yi Xue Ke Xue Za Zhi 1989;5:24 –30. 3. Bacsal KE, Chee SP, Cheng CL, Flores JV. Dengue-associated maculopathy. Arch Ophthalmol 2007;125:501–10. 4. Sanjay S, Wagle AM, Au Eong KG. Optic neuropathy associated with dengue fever. Eye 2008;22:722– 4. 5. Miranda de Sousa A, Puccioni-Sohler M, Dias Borges A, et al. Post-dengue neuromyelitis optica: case report of a Japanesedescendent Brazilian child. J Infect Chemother 2006;12:396 – 8.
Author reply Dear Editor: We read with interest the Letter to the Editor from Sanjay et al. First of all, we apologize to these authors and to the journal. We erroneously wrote our names in the wrong order. In the
170
right order (first name then last name), the authors names for our paper are: Laurence Beral, Harold Merle, and Thierry David. Second, believe that we have presented the first small series of loss of vision owing to optic neuritis in dengue fever. As a matter of fact, there are only 3 similar cases in the literature in 3 different articles.1–3 All the other articles reported in the literature describe other fundus abnormalities associated with optic disk swelling responsible for the loss of vision in the context of dengue fever: macular and retinal hemorrhages, peripapillary hemorrhages, Roth’s spot, and diffuse retinal edema.4,5 On the contrary, our patients differ by the fact that their fundus examination only displayed optic disk swelling. Therefore, we believe the loss of vision should only be attributed to optic neuritis. Finally, we agree that dengue fever rarely presents with central nervous manifestations; however, the pathophysiologic mechanisms responsible for dengue nervous system effects are not completely understood. As has already been reported by several authors, we offered our hypothesis based on a possible similarity between the mechanisms involved in dengue infection of endothelial cells and the nervous system affects of this virus.5 LAURENCE BERAL, MD HAROLD MERLE, MD THIERRY DAVID, MD Les Abymes, Guadeloupe References 1. Miranda de Sousa A, Puccioni-Sohler M, Dias Borges A, et al. Post-dengue neuromyelitis optica: case report of a Japanesedescendent Brazilian child. J Infect Chemother 2006;12: 396 – 8. 2. Preechawat P, Poonyathalang A. Bilateral optic neuritis after dengue viral infection. J Neuro-ophthalmol 2005;25:51–2. 3. Haritoglou C, Dotse SD, Rudolph G, et al. A tourist with dengue fever and visual loss. Lancet 2002;360:1070. 4. Sanjay S, Wagle AM, Au Eong KG. Optic neuropathy associated with dengue fever. Eye 2008;22:722– 4. 5. Lim WK, Mathur R, Koh A, et al. Ocular manifestations of dengue fever. Ophthalmology 2004;111:2057– 64.
Upper Eyelid Laxity Dear Editor: We were pleased to read the paper by Mills et al1 regarding evaluation of upper eyelid position after horizontal surgical tightening in patients with floppy eyelid syndrome (FES). In their study, the main outcome measure was the change in upper eyelid margin reflex distance after standard pentagonal wedge resection, in a series of 24 eyelids in 18 patients. The authors correctly noted a limitation of their study, which was that the degree of eyelid laxity was not graded before surgery. One of the most important etiological factors in eyelid malposition is laxity of the canthal tendons.2 Therefore, clinical assessment of the medial and lateral canthal tendons (MCT and LCT) is essential to the understanding and management of many eyelid disorders. In 2002, we described a simple and easily remembered clinical grading scheme for
Dengue Optic Neuropathy Dear Editor: We read with interest the article by Laurence et al1 reporting 3 cases of optic neuritis attributed to dengue fever. The authors have erroneously stated that only 3 cases of optic neuritis associated with dengue virus infection have been reported in the literature and that “we report the first small series of patients with optic neuritis attributed to dengue fever in the literature.” Optic nerve involvement in dengue fever is indeed rare, but reported cases seem to be on the rise in recent years. To the best of our knowledge, Wen et al2 were the first to report a case of optic neuritis in their series of 24 cases of ocular involvement after dengue fever. Another retrospective case series of 41 patients with dengue maculopathy also included 8 eyes with disc edema and 10 eyes with disc hyperemia, presumably signs of optic nerve involvement.3 More recently, our series of 3 cases of dengue fever-associated optic neuropathy was published online in March 2008.4 Despite the high prevalence of dengue fever in tropical and subtropical areas of the world and the proposed tropism of Arboviruses for the central nervous system, dengue fever rarely presents with central nervous manifestations.1– 4 Neuromyelitis optica has been reported after dengue fever, albeit rarely.5 None of our cases had neurologic symptoms.4 We agree with Laurence et al1 that ocular involvement in dengue fever patients may occasionally result in profound permanent visual impairment. One of the cases reported by us lost light perception in the presenting eye despite treatment with a course of intravenous methylprednisolone.4 SRINIVASAN SANJAY, MRCS(EDIN) AJEET M. WAGLE, FRCS(EDIN) KAH-GUAN AU EONG, FRCS(EDIN) Singapore References 1. Beral L, Merle H, David T. Ocular complications of dengue fever. Ophthalmology 2008;115:1100 –1. 2. Wen KH, Sheu MM, Chung CB, et al. The ocular fundus findings in dengue fever [Article in Chinese] Gaoxiong Yi Xue Ke Xue Za Zhi 1989;5:24 –30. 3. Bacsal KE, Chee SP, Cheng CL, Flores JV. Dengue-associated maculopathy. Arch Ophthalmol 2007;125:501–10. 4. Sanjay S, Wagle AM, Au Eong KG. Optic neuropathy associated with dengue fever. Eye 2008;22:722– 4. 5. Miranda de Sousa A, Puccioni-Sohler M, Dias Borges A, et al. Post-dengue neuromyelitis optica: case report of a Japanesedescendent Brazilian child. J Infect Chemother 2006;12:396 – 8.
Author reply Dear Editor: We read with interest the Letter to the Editor from Sanjay et al. First of all, we apologize to these authors and to the journal. We erroneously wrote our names in the wrong order. In the
170
right order (first name then last name), the authors names for our paper are: Laurence Beral, Harold Merle, and Thierry David. Second, believe that we have presented the first small series of loss of vision owing to optic neuritis in dengue fever. As a matter of fact, there are only 3 similar cases in the literature in 3 different articles.1–3 All the other articles reported in the literature describe other fundus abnormalities associated with optic disk swelling responsible for the loss of vision in the context of dengue fever: macular and retinal hemorrhages, peripapillary hemorrhages, Roth’s spot, and diffuse retinal edema.4,5 On the contrary, our patients differ by the fact that their fundus examination only displayed optic disk swelling. Therefore, we believe the loss of vision should only be attributed to optic neuritis. Finally, we agree that dengue fever rarely presents with central nervous manifestations; however, the pathophysiologic mechanisms responsible for dengue nervous system effects are not completely understood. As has already been reported by several authors, we offered our hypothesis based on a possible similarity between the mechanisms involved in dengue infection of endothelial cells and the nervous system affects of this virus.5 LAURENCE BERAL, MD HAROLD MERLE, MD THIERRY DAVID, MD Les Abymes, Guadeloupe References 1. Miranda de Sousa A, Puccioni-Sohler M, Dias Borges A, et al. Post-dengue neuromyelitis optica: case report of a Japanesedescendent Brazilian child. J Infect Chemother 2006;12: 396 – 8. 2. Preechawat P, Poonyathalang A. Bilateral optic neuritis after dengue viral infection. J Neuro-ophthalmol 2005;25:51–2. 3. Haritoglou C, Dotse SD, Rudolph G, et al. A tourist with dengue fever and visual loss. Lancet 2002;360:1070. 4. Sanjay S, Wagle AM, Au Eong KG. Optic neuropathy associated with dengue fever. Eye 2008;22:722– 4. 5. Lim WK, Mathur R, Koh A, et al. Ocular manifestations of dengue fever. Ophthalmology 2004;111:2057– 64.
Upper Eyelid Laxity Dear Editor: We were pleased to read the paper by Mills et al1 regarding evaluation of upper eyelid position after horizontal surgical tightening in patients with floppy eyelid syndrome (FES). In their study, the main outcome measure was the change in upper eyelid margin reflex distance after standard pentagonal wedge resection, in a series of 24 eyelids in 18 patients. The authors correctly noted a limitation of their study, which was that the degree of eyelid laxity was not graded before surgery. One of the most important etiological factors in eyelid malposition is laxity of the canthal tendons.2 Therefore, clinical assessment of the medial and lateral canthal tendons (MCT and LCT) is essential to the understanding and management of many eyelid disorders. In 2002, we described a simple and easily remembered clinical grading scheme for