Visual outcomes in children in Malawi following retinopathy of severe malaria

Abstract

Aim: To investigate whether retinal changes in children with severe malaria affect visual acuity 1 month after systemic recovery. Methods: All children with severe malaria admitted to a research ward in Malawi during one malaria season were examined by direct and indirect ophthalmoscopy. Visual acuity was tested in those attending follow up by Cardiff cards, Sheridan-Gardiner single letters, or Snellen chart. Results: 96 (68%) children attended follow up, of whom 83 (86%) had visual acuity measured. Cardiff cards were used in 47 (57%) children, and Sheridan-Gardiner letters or Snellen chart in 29 (35%). There was no significant difference in the mean logMAR visual acuity between groups with or without macular whitening (0.14 versus 0.16, p = 0.55). There was no trend for worse visual acuity with increasing severity of macular whitening (p = 0.52) including patients in whom the fovea was involved (p = 0.32). Six (4.2%) children had cortical blindness after cerebral malaria, and all six had other neurological sequelae. Ophthalmoscopy during the acute illness revealed no abnormalities in four of these children. Conclusion: Retinal changes in severe malaria, in particular macular whitening, do not appear to affect visual acuity at 1 month. This supports the hypothesis that retinal whitening is due to reversible intracellular oedema in response to relative hypoxia, caused by sequestered erythrocytes infected by Plasmodium falciparum. Impaired visual functioning after cerebral malaria is not attributable to retinal changes and appears to be a cortical phenomenon.

The effects of hypoxia on the ERG in paediatric cerebral malaria

“…3 A mechanism of metabolic steal by intravascular sequestered parasites has been suggested. 11,18 In conclusion these data show that the presence of increasingly severe retinal whitening (retinal CNP/ hypoxia) in CM retinopathy is associated with significant changes in cone b wave function.…”

“…8 It has also been described elsewhere that observed MW seems to be reversible with no adverse visual sequelae. 11 Current data obtained earlier from healthy children, show increasing ERG amplitudes with increasing age. 6 This was therefore identified as an anticipated source of bias before our study.…”

To Study the Association of Retinopathy with Plasmodium Species in Children’s with Cerebral Malaria

“…Thus Plasmodium falciparum was the most common cause of cerebral malaria. Jain, et al had also reported 96%cases of cerebral malaria caused by Plasmodium falciparumin their study [12] . In our study we also found cases of cerebral malaria which were caused by plasmodium vivax which was in accordance with the observation of Ahmed [13] and Gopinathan [14] .…”

Glasgow Coma Score as a Predictor for Development of Retinoptathy in Children’s with Cerebral Malaria

“…Beare, et al (2004) [9] reported 61% while Birbeck, et al (2010) [10] reported 79% incidence of retinopathy in their studies of cerebral malaria. Mortality reported by various authors in patient having any fundal abnormality was 21% in children (Beare, et al 2004) [9] and 24% in adults (Kochar & Shubhakaran, et al 1998) [11] . In CM groupon the basis of GCS we found that 79% patients with Glasgow score less than or equal to 6 had retinopathy, while only 35% who had Glasgow score more than 6 had retinopathy.…”