Pneumatic Displacement of a Dense Sub-inner Limiting Membrane Pre-macular Hemorrhage in Dengue Maculopathy: A Novel Treatment Approach

Sub-inner limiting membrane (ILM) hemorrhage is a rare presenting feature of dengue maculopathy. A 24-year-old man in active military service who was recently treated for dengue hemorrhagic fever presented with sub-ILM bleeding in right eye (dominant eye) with profound diminution of vision. Spectral domain optical coherence tomography and fundus fluorescein angiography confirmed sub-ILM hemorrhage with no evidence of vasculitis/venous occlusion or neovascularization. He refused active surgical management by pars plana vitrectomy and was treated with pneumatic tamponade of C3F8 (100%) gas with prone positioning in order to achieve faster visual recovery. He responded well to treatment with complete visual recovery in 1 week. This case report documents for the first time treatment of sub-ILM hemorrhage in the premacular area with pneumatic tamponade in prone position leading to rapid and complete visual recovery in a patient with dengue maculopathy. This novel approach can be employed for patients who are ineligible for more active surgical management.