Dear Editor:

We would like to thank Levaggi et al for replying to the issue of bilateral acute angle closure in a patient with dengue⁽¹⁾. As mentioned, angle closure is a possible ocular issue in dengue, even if it usually is a forgotten or underreported issue. As noted in the review by Ranjan and Ranjan in reference to previously published articles^(2-4), “Other rarely reported anterior segment signs include dengue-related shallowing of anterior chamber with normal intraocular pressure (IOP) following bilateral choroidal effusion, and shallow anterior chamber with raised IOP due to bilateral angle closure glaucoma in a patient with dengue fever”⁽²⁾. Regarding the claim that there should be other similar reports on acute angle closure in dengue in addition to the two published in Arq Bras Oftalmol, we can confirm the similar nature of the reports by Stewart et al⁽⁴⁾ and Saranappa et al⁽⁵⁾, and the report by Nagaraj et al on a dengue patient with acute increased IOP due to hemorrhagic episode-another good example confirming that the problem of IOP abnormality due to dengue pathology is real⁽⁶⁾. However, we still maintain that there are only two reports of bilateral acute angle closure. In fact, a case of acute angle closure developed few days after dengue is also reported in the literature, but in that case, another bacterial infection was mentioned as the cause of the problem⁽⁷⁾.

REFERENCES

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

2. Ranjan S, Ranjan R. Dengue-related ocular pathology: A Review. 2013 4(9):452-60.

3. Cruz-Villegas V, Berrocal AM, Davis JL. Bilateral choroidal effusions associated with dengue fever. Retina. 2003;23:576-8.

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.

6. Nagaraj KB, Jayadev C, Yajmaan S1, Prakash S. An unusual ocular emergency in severe dengue. Middle East Afr J Ophthalmol. 2014 Oct-Dec;21(4):347-9.

7. Tan N, Galvante PR, Chee SP. Endogenous Serratia marcescens endophthalmitis: an atypical presentation. Eye (Lond). 2014;28(1): 108-9.

Submitted for publication: March 27, 2018.
Accepted for publication: March 27, 2018.

Funding: No specific financial support was available for this study

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