• OCT Findings in Retinal Lesions of Infants With Zika Syndrome

    Written By: Lynda Seminara and selected by Neil M. Bressler, MD

    Journal Highlights

    JAMA Ophthalmology, December 2016

    Download PDF


    Maternal intrauterine infection with Zika virus (ZIKV) can cause severe ocular abnormalities in offspring. Ventura et al. performed a prospective cross-sectional study of 8 consecutive infants with congenital Zika syndrome (CZS) who were evaluated with optical coherence tomography (OCT). In addition to CZS manifestations that are typical of intrauterine ZIKV infection (e.g., microcephaly, hearing loss, limb malformations, and ocular anomalies), the authors found that CZS involves discontinuity of the ellipsoid zone, with retinal and choroidal thinning and hyperreflectivity beneath the retinal pigment epithelium (RPE).

    The 8 patients (5 females, 3 males; mean age, 4.1 months) were born in Pernambuco, Brazil, and received serologic testing to rule out other congenital infections. All patients had retinal lesions (determined by indirect ophthalmoscopy), and fundus exam­inations were performed at the initial visit. Cerebrospinal fluid samples were obtained from 7 of the 8 patients to determine whether ZIKV-specific IgM was present; all 7 had positive results. Seven patients were imaged by Fouri­er-domain OCT, and 1 patient under­went spectral-domain OCT. Because of the challenges associated with perform­ing OCT in infants, some images could not be acquired.

    On fundus examination, macular findings were chorioretinal scarring (10 of 16 eyes) and pigment mot­tling (7 eyes). Retinal abnormalities were observed in 11 of 16 eyes (69%). Of these 11 eyes, 9 were successfully scanned with OCT (1 unaffected eye was scanned). OCT of all 9 eyes (100%) indicated discontinuity of the ellipsoid zone and hyperreflectivity underlying the RPE. In addition, 8 eyes (89%) exhibited retinal thinning, 7 eyes (78%) had choroidal thinning, and 4 eyes (44%) showed colobomatous-like exca­vations of the retina, RPE, and choroid. Less common OCT findings included hyperreflective dots on the inner retinal layers (1 eye) and possible cleft (3 eyes).

    To the authors’ knowledge, this study is the first to employ OCT in the evaluation of retinal abnormalities in infants with presumed intrauterine ZIKV infection. They concluded that CZS is associated with severe damage to the choroid and to internal and exter­nal layers of the neurosensory retina.

    The original article can be found here.