A specific retinopathy has been described in African children with
cerebral malaria, but in adults this has not been extensively studied. Since the structure and function of the retinal vasculature greatly resembles the cerebral vasculature, study of
retinal changes can reveal insights into the pathophysiology of
cerebral malaria. A detailed observational study of malarial retinopathy in Bangladeshi adults was performed using high-definition portable
retinal photography. Retinopathy was present in 17/27 adults (63%) with severe
malaria and 14/20 adults (70%) with
cerebral malaria. Moderate or severe retinopathy was more frequent in
cerebral malaria (11/20, 55%) than in uncomplicated
malaria (3/15, 20%; P=0.039), bacterial
sepsis (0/5, 0%; P=0.038) or healthy controls (0/18, 0%; P<0.001). The spectrum of malarial retinopathy was similar to that previously described in African children, but no vessel discolouration was observed. The severity of
retinal whitening correlated with admission venous plasma
lactate (P=0.046), suggesting that
retinal ischaemia represents systemic ischaemia. In conclusion,
retinal changes related to microvascular obstruction were common in adults with severe
falciparum malaria and correlated with disease severity and
coma, suggesting that a compromised microcirculation has important pathophysiological significance in severe and
cerebral malaria. Portable
retinal photography has potential as a valuable tool to study malarial retinopathy.