PHOTOGRAPHIC AND ANGIOGRAPHIC CHARACTERIZATION OF THE RETINA OF KENYAN CHILDREN WITH SEVERE MALARIA

Objective: To investigate retinal lesions in children with severe falc iparum malaria. Methods: Color photography and fluorescein angiography were performed in consecutive children admitted to a pediatric high-d ependency unit in Kenya during 1 malaria-season. The presence and cate gory of retinal lesion was compared with disease severity, clinical ou tcome, anemia, lactic acidosis, and parasite count. Results: Twenty-si x patients with cerebral malaria and 14 patients who were prostrate we re studied. Thirty-one of the patients had clinical features of ocular disease, including round, flame-shaped, and white-centered hemorrhage s; peripheral and foveal retinal opacification; peripheral vascular oc clusion; venous dilation; disc edema with hyperemia; and arterial puls atility. Of 8 patients with retinal opacification, only 2 showed small , infrequent zones of capillary nonperfusion on fluo- rescein angiogra phy; the leakage of dye at sites of opacification was not seen. Retina l opacification was significantly associated with a higher parasite co unt (P<.02). White-centered hemorrhages were significantly associated with a higher parasite count (P<.05), severe disease (P<.05), and seve re anemia (P<.02). Conclusions: The blood-retina barrier and retinal v ascular flow remain substantially normal despite widespread pathologic al features. Retinal features in children with severe malaria are cons istent with cellular hypoxia, nutritional deficiency, or both rather t han with vascular occlusion; they support the concept of metabolic ste al by parasites.