==== Front Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 10.5144/0256-4947.2013.82asm-1-82aCommentsOphthalmic complications of dengue: pathogenesis and prevention Uma Alagappan aPrabhu Nagarajan aThirumalaikolundusubramanian Ponniah b a Department of Microbilogy, Chennai Medical College Hospital and Research Centre, Irungalur, Tiruchirapalli, India b Department of Medicine, Chennai Medical College Hospital and Research Centre, Irungalur, Tiruchirapalli, IndiaCorrespondence: Najarajan Prabhu, Chennai Medical College Hospital and Research Centre, Irungalur, Tiruchirapalli, 621 105, India, leptoprabhu@gmail.comJan-Feb 2013 33 1 82 82 Copyright © 2013, Annals of Saudi Medicine2013This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. ==== Body To The Editor: The report of Tabbara1 on dengue retinochroiditis is timely and makes practitioners and physicians to consider various ophthalmic manifestations and complications of dengue fever. Unfortunately these are discussed seldom during clinical rounds and teaching sessions. It is surprising that ophthalmic complications were not cited much in recent papers.2,3 As genetic susceptibility4 is known for dengue infections, genetic predisposition might explain the susceptibility of a subset of dengue affected individuals for ophthalmic complications which needs further study. Recently ophthalmic manifestations following West Nile virus infection, another flavivirus, have been reported,5 so the author could have considered West Nile infection also. Additional investigations such as functional status of platelets, platelet receptor polymorphism, defects in megakaryotes and platelet antibodies might have carried out in order to rule out platelet dysfunction as a contributory factor for hemaorrhagic episodes observed in the case reported. Dengue virus appears to infect the endothelial cells of blood vessels. As angiotension converting enzyme inhibitors (ACEIs) have a protective effect on blood vessels, the chemoprophylactic effects of ACEIs to prevent vasculogenic (vascular) complications of dengue fever are worth exploring. Also, it might be interesting to observe whether patients on ACEIs escape vasculogenic complications, if they are infected by dengue fever virus. Investigators need to identify the various target proteins, amino acid residues and mimickers of amino acid residues, and their binding activity to dengue viral infection triggers or alters the immune mechanism resulting in post-dengue ophthalmic complications.6 Overall, there is a need to identify the susceptible population for complications of dengue fever and to introduce prophylactic agents to prevent or minimize complications of dengue fever. ==== Refs REFERENCES 1 Tabbara K Dengue retinochoroiditis Ann Saudi Med 2012 32 5 530 33 22871625 2 Simmons CP Farreer JJ Chan NV Wills B Dengue: Current concepts New Engl J Med 2012 366 1423 32 22494122 3 Gupta N Srivastava S Jain A Chaturvedi VC Dengue in India Ind J Med Res 2012 136 373 90 4 Coffey LL Mertens E Brehin AC Human genetic determination of dengue virus susceptibility Microb Infect 2009 11 143 56 5 Shukla J Saxena D Rathinam S Lalitha P Joseph CR Sharma S Soni M Rao PVL Parida M Molecular detection and characterization of West Nile virus associated with multifocal retinitis in patients from Southern India Int J Infect Dis 2011 16 1 53 9 6 Liu IJ Chiu CY Chen YU Wu HC Molecular mimicry of human epithelial cell antigen by autoantibodies to nonstructural protein 1 of dengue virus J Biol Chem 2011 286 11 9723 36