Prenatal and Postnatal Ocular Abnormalities Following Congenital Zika Virus Infections: A Systematic Review
Anis Mahmoud1,2, Léo Pomar3,4, Veronique Lambert5
1Department of Ophthalmology, Tahar Sfar University Hospital, Mahdia, Tunisia.
Insights
Congenital Zika virus (ZIKV) infection causes severe fetal and neonatal eye abnormalities, including microphthalmia and posterior segment damage. These conditions can lead to long-term visual impairment, emphasizing the need for early detection and multidisciplinary care.
Area of Science:
- Ophthalmology
- Maternal-Fetal Medicine
- Virology
Background:
- The Zika virus (ZIKV) outbreak highlighted significant risks for fetal and neonatal ocular development.
- Congenital ZIKV infection can lead to a spectrum of severe eye abnormalities, necessitating a comprehensive understanding of their progression.
Approach:
- A systematic review and meta-analysis was performed by obstetricians and ophthalmologists.
- Included studies reported on ocular abnormalities during prenatal and postnatal periods.
Key Points:
- Prenatal findings included intraocular calcification and microphthalmia.
- Postnatal abnormalities predominantly affected the posterior segment (retina, optic nerve) with pigmentary changes, macular atrophy, and optic nerve issues.
- Anterior segment involvement included cataracts and congenital glaucoma; multiple anomalies were common.
- Long-term visual disorders were observed, with some cases showing worsening conditions.
Conclusions:
- Congenital ZIKV infection is associated with severe ocular abnormalities.
- Multidisciplinary collaboration among obstetricians, maternal-fetal medicine specialists, and ophthalmologists is crucial for managing these cases.
Objective:
To assess fetal and neonatal eyes abnormalities and their progression during the last ZIKV outbreak and summarize learned lessons.
Methods:
A systematic review and meta-analysis was conducted by a team of obstetricians and ophthalmologists.
Results:
Studies reporting ocular abnormalities during the prenatal (n = 5) and postnatal (n = 24) periods were included in the analysis. In the prenatal period, the most common ocular findings were intraocular calcification cases (4/6, 66.6%) and microphthalmia (3/6, 50%). Postnatal ocular abnormalities of congenital ZIKV infection were described after birth in 479 cases. Among them microphthalmia was reported in 13 cases (13/479, 2.7%). Posterior segment (retina and optic nerve) was the most affected structure, consisting of pigmentary changes (229/479, 47.8%), macular chorioretinal atrophy (216/479, 45%), optic nerve atrophy (181/479, 37.8%), increased cup-to-disk ratio (190/479, 39.6.%), optic nerve hypoplasia (93/479,19.4%), vascular changes (26/479, 5.4%), and retinal coloboma (20/479, 4.1%). The anterior segment was involved in 4.6% (22/479) of cases, including cataract (9/479, 1.8%), lens subluxation (1/479, 0.2%), iris coloboma (5/479, 1%), and congenital glaucoma (7/479, 1.4%). These ocular anomalies were isolated in one case (1/479, 0.2%) and multiple anomalies were found in the other cases. Long-term visual disorders have been described, with no possible improvement and even a worsening of some of the ocular anomalies previously observed. No reactivation of ocular lesions was observed.
Conclusion:
This review highlights the severe ocular abnormalities associated with congenital ZIKV infections. The importance of multidisciplinary communication between the obstetrician, the maternal-fetal medicine specialist, and the ophthalmologist is emphasized.
Protocol Registration:
This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration440 188.
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