Ophthalmological manifestations in congenital Zika syndrome in 469 Brazilian children
Camila V Ventura1, Andrea Zin2, Bruno de Paula Freitas3
1Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil.
Insights
Congenital Zika syndrome (CZS) affects one-third of children, causing ocular manifestations like optic nerve pallor and chorioretinal scars. Infants in Pernambuco, Brazil, showed a higher prevalence of these eye conditions.
Area of Science:
- Ophthalmology
- Pediatrics
- Infectious Diseases
Background:
- Congenital Zika syndrome (CZS) is a severe condition resulting from prenatal Zika virus infection.
- Ophthalmologic complications are a significant concern in infants diagnosed with CZS.
Purpose of the Study:
- To analyze the spectrum of ophthalmologic manifestations in a large cohort of children with CZS in Brazil.
- To identify the prevalence and types of eye abnormalities in CZS-affected infants.
Main Methods:
- Retrospective review of medical records of infants diagnosed with CZS in Brazil (December 2015-December 2016).
- Inclusion criteria: positive Zika virus testing (RT-PCR or serology) and clinical CZS manifestations.
- Exclusion criteria: other congenital infections, genetic conditions, incomplete records.
Main Results:
- A total of 469 infants were included; 31.6% presented with ocular manifestations.
- Common findings included optic nerve pallor (13.0%), focal pigment mottling (11.9%), and chorioretinal scars (10.8%).
- Infants from Pernambuco showed a significantly higher prevalence of both microcephaly and ocular manifestations.
Conclusions:
- Approximately one-third of children with CZS exhibit ocular abnormalities.
- Ocular manifestations can occur even in the absence of microcephaly (7.5% of cases).
- Geographic disparities in affected populations, particularly higher rates in Pernambuco, were observed.
Purpose:
To analyze the spectrum of ophthalmologic manifestations in a large sample of children with congenital Zika syndrome (CZS) in Brazil.
Methods:
The medical records of infants born in the states of Pernambuco, Bahia, and Rio de Janeiro, Brazil, between December 2015 and December 2016 with clinical manifestations of CZS and positive reverse transcription polymerase-chain-reaction (RT-PCR) and/or serology for the Zika virus were reviewed retrospectively. Data were collected from the record of the first ophthalmological assessment, performed on admission. Children with other congenital infectious diseases, genetic conditions, and incomplete medical records were excluded.
Results:
A total of 469 infants (242 female [51.6%]) were included. Mean age at examination was 5.0 ± 7.1 months (range, 0.0-36.0 months). Of the 469 infants, 197 (42.0%) were from Rio de Janeiro, 144 (30.7%) from Pernambuco, and 128 (27.3%) from Bahia States. Microcephaly at birth was detected in 214 (45.6%) children; 62 cases (29.0%) were severe. Pernambuco had significantly more children born with microcephaly compared with Bahia and Rio de Janeiro (P < 0.001). Ocular manifestations were found in 269 of 938 eyes (28.7%; 148/469 children [31.6%]). The main ocular alterations were optic nerve pallor in 122 of 938 eyes (13.0%), focal pigment mottling in 112 eyes (11.9%), and chorioretinal scars in 101 eyes (10.8%). A higher prevalence of ocular manifestations was seen in Pernambuco (P < 0.001). No microcephaly was observed in 252 of 466 children (54.1%); of these, 19 children (7.5%) had funduscopic findings.
Conclusions:
One-third of children with CZS had ocular manifestations. Children from Pernambuco were more affected. Ocular abnormalities were found in 7.5% of children without microcephaly.
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