title: Ocular Findings in Infants With Microcephaly Associated With Presumed Zika Virus Congenital Infection in Salvador, Brazil.
abstract: OBJECTIVE
  The Zika virus (ZIKV) has rapidly reached epidemic proportions, especially in northeastern Brazil, and has rapidly spread to other parts of the Americas. A recent increase in the prevalence of microcephaly in newborn infants and vision-threatening findings in these infants is likely associated with the rapid spread of ZIKV.
  
  
  OBJECTIVE
  To evaluate the ocular findings in infants with microcephaly associated with presumed intrauterine ZIKV infection in Salvador, Bahia, Brazil.
  
  
  METHODS
  Case series at a tertiary hospital. Twenty-nine infants with microcephaly (defined by a cephalic circumference of ≤32 cm) with a presumed diagnosis of congenital ZIKV were recruited through an active search and referrals from other hospitals and health unities. The study was conducted between December 1 and December 21, 2015.
  
  
  METHODS
  All infants and mothers underwent systemic and ophthalmic examinations from December 1 through December 21, 2015, in the Roberto Santos General Hospital, Salvador, Brazil. Anterior segment and retinal, choroidal, and optic nerve abnormalities were documented using a wide-field digital imaging system. The differential diagnosis included toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, syphilis, and human immunodeficiency virus, which were ruled out through serologic and clinical examinations.
  
  
  METHODS
  Ocular abnormalities associated with ZIKV.
  
  
  RESULTS
  Twenty-three of 29 mothers (79.3%) reported suspected ZIKV infection signs and symptoms during pregnancy, 18 in the first trimester, 4 in the second trimester, and 1 in the third trimester. Of the 29 infants (58 eyes) examined (18 [62.1%] female), ocular abnormalities were present in 17 eyes (29.3%) of 10 children (34.5%). Bilateral findings were found in 7 of 10 patients presenting with ocular lesions, the most common of which were focal pigment mottling of the retina and chorioretinal atrophy in 11 of the 17 eyes with abnormalities (64.7%), followed by optic nerve abnormalities in 8 eyes (47.1%), bilateral iris coloboma in 1 patient (2 eyes [11.8%]), and lens subluxation in 1 eye (5.9%).
  
  
  CONCLUSIONS
  Congenital infection due to presumed ZIKV exposure is associated with vision-threatening findings, which include bilateral macular and perimacular lesions as well as optic nerve abnormalities in most cases.
authors: Department of Ophthalmology, Hospital Geral Roberto Santos, Salvador, Brazil.
authors: Bruno
authors: B
authors: de Paula Freitas
authors: Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil.
authors: João Rafael
authors: JR
authors: de Oliveira Dias
authors: Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil.
authors: Juliana
authors: J
authors: Prazeres
authors: Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Salvador, Brazil.
authors: Gielson Almeida
authors: GA
authors: Sacramento
authors: Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Salvador, Brazil4Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
authors: Albert Icksang
authors: AI
authors: Ko
authors: Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil.
authors: Maurício
authors: M
authors: Maia
authors: Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil.
authors: Rubens
authors: R
authors: Belfort