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Ophthalmic Images

Bilateral macular Roth spots as a rare manifestation of hemoglobin E trait

Gupta, Krati; Das, Dipankar1; Deshmukh, Saurabh2,

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Indian Journal of Ophthalmology: October 2020 - Volume 68 - Issue 10 - p 2265
doi: 10.4103/ijo.IJO_2176_19
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A 13-year-old-male child presented for diminution of vision in left eye (OS). Vision was 20/20 in right eye (OD) and 20/200 OS. Fundus examination showed two Roth spots in macular region OD and one large Roth spot in the macular region involving fovea OS [Fig. 1a and b]. He had mild pallor. Hematological examination showed low hemoglobin and red cell indices, normal RBC count, platelet count, total leucocyte count, and differential leucocyte count. Blood smear showed anisopoikilocytosis, hypochromia, and microcytes [Fig. 1c]. High-performance liquid chromatography (HPLC) showed Hb E (same elution as Hb A2) 32.5% [Fig. 1d]. Hematological and HPLC findings confirmed the diagnosis of Hb E trait. Patient was treated with oral folic acid for anemia and at 6-month follow-up, Roth spots resolved and vision improved to 20/40 OS.

Figure 1
Figure 1:
Color fundus photograph of the (a) right eye showing multiple white-centered hemorrhages in the macular area, and (b) left eye showing a single large Roth spot involving the fovea. (c) Blood smear showing hypochromia and microcytes. (d) HPLC tracing showing findings diagnostic of Hb E trait; Hb A0 61.3%, Hb A2 (Hb E) 29.1%. (On HPLC, the elution time of Hb A2 and Hb E is same)

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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.


We would like to thank Sri Kanchi Sankara Health and Educational Foundation, Guwahati, India.

© 2020 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow