• Ophthalmic Manifestations of Congenital Zika Syndrome

    By Lynda Seminara and selected by Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, May 2017

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    Yepez et al. documented ophthalmic findings for infants with congenital Zika syndrome (CZS) in Colombia and Venezuela; they noted severe abnormalities, all of which were bilateral.

    This prospective case series included 43 infants (mean age, 2.1 months) with microcephaly and a clinical diagnosis of CZS. The patients’ mothers had no ophthalmic findings and did not report any ocular symptoms during pregnancy. All 43 infants underwent ophthalmic and systemic evaluations as well as serologic testing. Ocular examination included external assessment and dilated ophthalmoscopy. Choroidal anomalies were detected using wide-field digital imaging after pupillary dilation. Serologic testing was performed to rule out syphilis, rubella, toxoplasmosis, cytomegalovirus, and the human immunodeficiency virus.

    Bilateral ocular manifestations were present in all infants. Five (12%) had optic nerve findings of hypoplasia with the double-ring sign, pallor, and elevated cup-disc ratio. Macular defects included mild to severe pigment mottling in 27 patients (63%) and lacunar maculopathy in 3 (7%). Chorioretinal scarring occurred in 3 patients (7%). Eleven infants (26%) had lesions of various types in the posterior pole. Congenital glaucoma was diagnosed in 5 patients (12%), based on the classic triad; this finding has not been previously documented for patients with CZS. The effect of these ocular abnormalities on vision is not known.

    No other retinal defects were noted, and the retina was attached in all patients. No cases of uveitis were observed.

    The authors concluded that CZS with microcephaly is associated with a high rate of severe macular and optic nerve defects (88%) and a substantial rate of anterior segment anomalies (12%). Bilateral ocular involvement was universal in their study. Therefore, they recommend that an ophthalmic examination be performed on all patients with CZS.

    The original article can be found here.