Ophthalmic Manifestations of Congenital Zika Syndrome in Colombia and Venezuela

Abstract

The ocular manifestations and sequelae of Zika virus infection are not well known. Recently, the World Health Organization changed the declaration of Zika as a public health emergency and designated the viral outbreak and related microcephaly clusters as a long-term program of work. This change indicates the urgent need to evaluate and document ophthalmic manifestations in patients for timely management of this disease. In addition, confirmation whether the public health problem in Brazil extends to other regions in South America is needed. OBJECTIVE To report the ocular manifestations of congenital Zika syndrome with microcephaly in Colombia and Venezuela. DESIGN, SETTING, AND PARTICIPANTS This prospective case series included 43 patients from 2 ophthalmic centers in Colombia and Venezuela who underwent evaluation from October 1, 2015, through June 30, 2016, and were clinically diagnosed with congenital Zika syndrome. Twenty patients were Hispanic; 13, African; 8, white; and 2, Native American. INTERVENTIONS Ophthalmic and systemic evaluations and serologic testing were performed on all infants. Patients underwent external ocular examination and dilated ophthalmoscopy. Serologic testing ruled out toxoplasmosis, rubella, cytomegalovirus, syphilis, and human immunodeficiency virus. MAIN OUTCOMES AND MEASURES Ophthalmic manifestations of congenital Zika syndrome. RESULTS Of the 43 patients included in this series (28 female and 15 male), the mean (SD) age at examination was 2.1 (1.5) months. The mothers of all the children had no ophthalmic findings and did not report ocular symptoms during pregnancy. All patients had bilateral ophthalmic manifestations. Optic nerve findings included hypoplasia with the double-ring sign, pallor, and increased cup-disc ratio in 5 patients (11.6%). Macular abnormalities included mild to severe pigment mottling in 27 patients (63%) and lacunar maculopathy in 3 (6.9%). Chorioretinal scarring was present in 3 patients (7%). Eleven patients (26%) had a combination of lesions in the posterior pole. Five patients (12%) were diagnosed with congenital glaucoma, characterized by the clinical triad of epiphora, photophobia, and blepharospasm; increased intraocular pressure; corneal clouding at birth; and buphthalmos. These data reveal that 12% (95% CI, 5%-24%) of cases of congenital Zika with microcephaly had anterior segment abnormalities and 88% (95% CI, 76%-94%) had important macular and optic nerve abnormalities. The visual sequelae of these ophthalmic manifestations remain unknown. CONCLUSIONS AND RELEVANCE Congenital Zika syndrome in the current study had severe ocular abnormalities, and all patients had bilateral involvement. Ocular findings were focal macular pigment mottling, chorioretinal atrophy with a predilection for the macular area, congenital glaucoma and optical nerve hypoplasia, and optic disc abnormalities. Ophthalmic examination is recommended in patients with congenital Zika syndrome.

Ophthalmologic Manifestations Associated With Zika Virus Infection

“…10,11,14,15 These ocular findings were first described after being identified in infants from the state of Pernambuco, which is located in northeastern Brazil, and were later supported by other publications from other states in Brazil, including Bahia, Ceará, and Rio de Janeiro. 10 -14 More recently, Yepez et al 20 reported similar ocular manifestations in affected infants from Colombia and Venezuela, which reinforces the consistency of these findings and the importance of ocular screening in newborns with a high suspicion for CZS.…”

Existing drugs as broad-spectrum and potent inhibitors for Zika virus by targeting NS2B-NS3 interaction

“…Significant outbreaks of ZIKV, a re-emerging mosquito-borne flavivirus, have occurred worldwide since 2013 [1,2]. Importantly, ZIKV infection has led to a global crisis due to its unexpected links to testis damage [3,4], ocular damage [5,6], Guillain-Barre syndrome, fetal microcephaly [1,[7][8][9], and potentially to other neural complications [10][11][12].…”

Global Alert: Zika Virus-an Emerging Arbovirus

“…The most frequently reported were macular atrophy, pigment mottling (63%), optic nerve anomalies (such as hypoplasia with double ring sign) (11%), lacunar maculopathy (6.9%), foveal reflex loss, and increased cupdisk ratio [31,43,54,55]. Additionally, Yepez et al [54] recently reported congenital glaucoma, corneal clouding, buphthalmos, increased intraocular pressure, and the clinical triad of epiphora, blepharospasm, and photophobia in infants with microcephaly.…”