Optical Coherence Tomography of Retinal Lesions in Infants With Congenital Zika Syndrome.
OBJECTIVE
Zika virus (ZIKV) can cause severe changes in the retina and choroid that may result in marked visual impairment in infants with congenital Zika syndrome (CZS), the term created for a variety of anomalies associated with intrauterine ZIKV infection.


OBJECTIVE
To evaluate the affected retinal layers in infants with CZS and associated retinal abnormalities using optical coherence tomography (OCT).


METHODS
This cross-sectional, consecutive case series included 8 infants (age range, 3.0-5.1 months) with CZS. Optical coherence tomographic images were obtained in the affected eyes of 7 infants with CZS who had undergone previous ophthalmologic examinations on March 17, 2016, and in 1 infant on January 1, 2016. An IgM antibody-capture enzyme-linked immunosorbent assay for ZIKV was performed on the cerebrospinal fluid samples of 7 of the 8 infants (88%), and other congenital infections were ruled out.


METHODS
Observation of retinal and choroidal findings in the OCT images.


RESULTS
Among the 8 infants included in the study (3 male; 5 female; mean [SD] age at examination, 4.1 [0.7] months), 7 who underwent cerebrospinal fluid analysis for ZIKV had positive findings for IgM antibodies. Eleven of the 16 eyes (69%) of the 8 infants had retinal alterations and OCT imaging was performed in 9 (82%) of them. Optical coherence tomography was also performed in 1 unaffected eye. The main OCT findings in the affected eyes included discontinuation of the ellipsoid zone and hyperreflectivity underlying the retinal pigment epithelium in 9 eyes (100%), retinal thinning in 8 eyes (89%), choroidal thinning in 7 eyes (78%), and colobomatouslike excavation involving the neurosensory retina, retinal pigment epithelium, and choroid in 4 eyes (44%).


CONCLUSIONS
Zika virus can cause severe damage to the retina, including the internal and external layers, and the choroid. The colobomatouslike finding seen in the OCT images relate to the excavated chorioretinal scar observed clinically.
Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil3Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil4Bascom Palmer Eye Institute, Miami, Florida.
Camila V
CV
Ventura
Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil.
Liana O
LO
Ventura
Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil.
Vasco
V
Bravo-Filho
Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil.
Thayze T
TT
Martins
Bascom Palmer Eye Institute, Miami, Florida.
Audina M
AM
Berrocal
Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil.
Adriana L
AL
Gois
Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil4Bascom Palmer Eye Institute, Miami, Florida.
João Rafael
JR
de Oliveira Dias
Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil.
Leandro
L
Araújo
Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil.
Paulo
P
Escarião
Department of Pediatric Neurology, Barão de Lucena Hospital, Recife, Brazil.
Vanessa
V
van der Linden
Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Rubens
R
Belfort
Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Mauricio
M
Maia
D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D015828:Eye Infections, Viral / Q000151:congenital / Q000175:diagnosis* / Q000821:virology; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D007223:Infant; D008297:Male; D012160:Retina / Q000473:pathology*; D012164:Retinal Diseases / Q000151:congenital / Q000175:diagnosis*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity; D000071244:Zika Virus / Q000276:immunology; D000071243:Zika Virus Infection / Q000151:congenital / Q000175:diagnosis* / Q000821:virology