Visual impairment in children with congenital Zika syndrome
Liana O Ventura1, Camila V Ventura2, Linda Lawrence3
1Altino Ventura Foundation (FAV), Recife, PE, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, PE, Brazil.
Insights
All infants with congenital Zika syndrome (CZS) experienced visual impairment. This suggests that cerebral visual impairment is the primary cause of blindness in children with CZS, even without retinal or optic nerve issues.
Area of Science:
- Ophthalmology
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Congenital Zika syndrome (CZS) is a condition resulting from prenatal Zika virus infection.
- Visual impairment is a significant concern in infants diagnosed with CZS.
- Understanding the spectrum of visual deficits is crucial for early intervention.
Purpose of the Study:
- To characterize visual impairment in infants with CZS.
- To correlate visual deficits with ocular and neurological abnormalities.
- To identify the primary causes of blindness in this cohort.
Main Methods:
- Cross-sectional study of 32 infants with microcephaly born in Brazil.
- Confirmed Zika virus infection via cerebrospinal fluid analysis.
- Comprehensive ophthalmologic and neurologic examinations, including neuroimaging.
Main Results:
- 100% of infants (32/32) exhibited visual impairment.
- Ocular findings (retinal/optic nerve) were present in 44% (14/32).
- All infants (100%) had neurological and neuroimaging abnormalities.
Conclusions:
- Visual impairment is universal in children with CZS.
- Cortical/cerebral visual impairment is likely the predominant cause of blindness.
- Ocular findings are not necessary for visual impairment diagnosis in CZS.
Purpose:
To describe the visual impairment associated with ocular and neurological abnormalities in a cohort of children with congenital Zika syndrome (CZS).
Methods:
This cross-sectional study included infants with microcephaly born in Pernambuco, Brazil, from May to December 2015. Immunoglobulin M antibody capture enzyme-linked immunosorbent assay for the Zika virus on the cerebrospinal fluid samples was positive for all infants. Clinical evaluation consisted of comprehensive ophthalmologic examination including visual acuity, visual function assessment, visual developmental milestone, neurologic examination, and neuroimaging.
Results:
A total of 32 infants (18 males [56%]) were included. Mean age at examination was 5.7 ± 0.9 months (range, 4-7 months). Visual function and visual developmental milestone could not be tested in 1 child (3%). Visual impairment was detected in 32 infants (100%). Retinal and/or optic nerve findings were observed in 14 patients (44%). There was no statistical difference between the patients with ocular findings and those without (P = 0.180). All patients (100%) demonstrated neurological and neuroimaging abnormalities; 3 (9%) presented with late-onset of microcephaly.
Conclusions:
Children with CZS demonstrated visual impairment regardless of retina and/or optic nerve abnormalities. This finding suggests that cortical/cerebral visual impairment may be the most common cause of blindness identified in children with CZS.
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