Retinal changes in adults with cerebral malaria

Cerebral malaria (CM) is associated with several retinal signs that together constitute a retinopathy unique to severe malaria. This has been described in detail in children in Malawi Kenya and The Gambia (Lewallen et al. 1996 1999; Hero et al. 1997). Papilloedema also occurs and together with the retinal changes is predictive of disease outcome (Lewallen et al. 1996; N. Beare unpubl. obs.). The retinopathy is common in children with CM occurring in about two thirds but has not been described in adults. The retinal changes which are best seen by indirect ophthalmoscopy include patchy whitening of the macula whitening of the peripheral retina discoloration of the retinal vessels to pale orange or white and multiple (predominantly white-centred) retinal haemorrhages. The vessel discoloration is associated with the sequestration of dehaemoglobinized erythrocytes in the retinal vessels (Lewallen et al. 2000) but the pathophysiology of the macular and peripheral retinal whitening remains unclear. (excerpt)