Dear Editor:

We appreciate the correspondence article “Bilateral acute angle closure in a patient with dengue” by Joob et al.⁽¹⁾ and their interest in our article “Bilateral acute angle closure in a patient with dengue fever: a case report”⁽²⁾. In the letter, they mention the existence of two articles describing bilateral acute angle closures^(4,5) in addition to the two reports presented in this journal^(2,3). We are fully aware of those two reports but we disagree because while all four articles present cases of ocular hypertension during dengue fever, the additional articles do not describe the cases of bilateral acute angle closure.

In the report published by Stewart et al.⁽⁴⁾, a patient presented with bilateral hypertensive panuveitis with scattered anterior synechiae in OD and a wide open chamber in OS. The authors presumed both an inflammatory glaucoma and a steroid-induced glaucoma response, but not in relation to an acute angle closure. In the report published by Saranappa and Sowbhagya⁽⁵⁾, another patient presented a unilateral panophthalmitis associated with ocular hypertension during dengue fever. This was a unilateral case, and the slit lamp evaluation of the eye was not entirely presented. Also, there was no clear description of the mechanism for ocular hypertension.

Ocular manifestations caused by flavivirus infections are a relevant subject that has recently become popular among researchers. Due to their low incidence, most of the known information is acquired from case series and reports. Therefore, we considered it imperative to separate the different mechanisms responsible for ocular hypertension. To the best of our knowledge, the report presented by Pierre Filho et al. and ours are the only two known cases of bilateral acute angle closure glaucoma during dengue fever. Both cases presented a bilateral narrow angle. In the first report, the characteristics of the angle were not described. In our case, the results of an ultrasound biomicroscopy study suggested an iris plateau configuration.

REFERENCES

1. Joob B, Wiwanitkit V. Bilateral acute angle closure in a patient with dengue. Arq Bras Oftalmol. 2018;81(1):80.

2. Levaggi ND, Lucas AN, Barletta JA. Bilateral acute angle closure in a patient with dengue fever: a case report. Arq Bras Oftalmol. 2017;80(4):266-7.

3. Pierre Filho P de T, Carvalho Filho JP, Pierre ET. Bilateral acute angle closure glaucoma in a patient with dengue fever: case report. Arq Bras Oftalmol. 2008;71(2):265-8.

4. Stewart KP, Tawakol JB, Khan T, Capriotti JA. Combination immunotherapy in the treatment of chronic bilateral panuveitis and uveitic glaucoma during acute dengue fever infection in the Caribbean. Int Med Case Rep J. 2015;8:151-3.

5. Saranappa SB, Sowbhagya HN. Panophthalmitis in dengue fever. Indian Pediatr. 2012;49(9):760.

Submitted for publication: March 15, 2018.
Accepted for publication: March 20, 2018.

Funding: No specific financial support was available for this study

Disclosure of potential conflicts of interest: None of the authors have any potential conflict of interest to disclose