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Optical Coherence Tomography of Retinal Lesions in Infants With Congenital Zika Syndrome
Camila V Ventura1, Liana O Ventura2, Vasco Bravo-Filho2
1Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil3Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil4Bascom Palmer Eye Institute, Miami, Florida.
Insights
Zika virus (ZIKV) causes severe retinal and choroidal damage in infants with congenital Zika syndrome (CZS), leading to vision impairment. Optical coherence tomography (OCT) revealed significant retinal layer thinning and pigment epithelium abnormalities.
Area of Science:
- Ophthalmology
- Virology
- Pediatrics
Background:
- Congenital Zika syndrome (CZS) is associated with severe ocular abnormalities in infants.
- Zika virus (ZIKV) infection during pregnancy can lead to significant visual impairment.
Observation:
- This study utilized optical coherence tomography (OCT) to examine retinal and choroidal layers in infants diagnosed with CZS.
- OCT imaging was performed on 9 affected eyes and 1 unaffected eye.
Findings:
- OCT revealed significant retinal abnormalities in infants with CZS, including ellipsoid zone discontinuation and retinal pigment epithelium hyperreflectivity (100%).
- Retinal thinning (89%), choroidal thinning (78%), and coloboma-like excavations (44%) were also observed.
- ZIKV IgM antibodies were detected in the cerebrospinal fluid of 7 out of 8 infants.
Implications:
- ZIKV infection can lead to profound and widespread damage to the retina and choroid.
- OCT is a valuable tool for diagnosing and characterizing the ocular manifestations of CZS.
- Understanding these findings is crucial for managing visual impairment in infants affected by ZIKV.
Importance:
Zika virus (ZIKV) can cause severe changes in the retina and choroid that may result in marked visual impairment in infants with congenital Zika syndrome (CZS), the term created for a variety of anomalies associated with intrauterine ZIKV infection.
Objective:
To evaluate the affected retinal layers in infants with CZS and associated retinal abnormalities using optical coherence tomography (OCT).
Design, Setting, And Participants:
This cross-sectional, consecutive case series included 8 infants (age range, 3.0-5.1 months) with CZS. Optical coherence tomographic images were obtained in the affected eyes of 7 infants with CZS who had undergone previous ophthalmologic examinations on March 17, 2016, and in 1 infant on January 1, 2016. An IgM antibody-capture enzyme-linked immunosorbent assay for ZIKV was performed on the cerebrospinal fluid samples of 7 of the 8 infants (88%), and other congenital infections were ruled out.
Main Outcomes And Measures:
Observation of retinal and choroidal findings in the OCT images.
Results:
Among the 8 infants included in the study (3 male; 5 female; mean [SD] age at examination, 4.1 [0.7] months), 7 who underwent cerebrospinal fluid analysis for ZIKV had positive findings for IgM antibodies. Eleven of the 16 eyes (69%) of the 8 infants had retinal alterations and OCT imaging was performed in 9 (82%) of them. Optical coherence tomography was also performed in 1 unaffected eye. The main OCT findings in the affected eyes included discontinuation of the ellipsoid zone and hyperreflectivity underlying the retinal pigment epithelium in 9 eyes (100%), retinal thinning in 8 eyes (89%), choroidal thinning in 7 eyes (78%), and colobomatouslike excavation involving the neurosensory retina, retinal pigment epithelium, and choroid in 4 eyes (44%).
Conclusions And Relevance:
Zika virus can cause severe damage to the retina, including the internal and external layers, and the choroid. The colobomatouslike finding seen in the OCT images relate to the excavated chorioretinal scar observed clinically.
