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Visual impairment associated with congenital Zika syndrome

Issue: June 2017

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LOS ANGELES — Babies presenting with congenital Zika syndrome can have significant visual impairment, regardless of whether they have other ocular findings, Camila Ventura, MD, said at Cornea Subspecialty Day preceding the American Society of Cataract and Refractive Surgery meeting.

“Regardless of ocular findings, all of the babies that were examined presented significant visual impairment, which means that probably the visual impairment is related to the cortical findings,” Ventura said.

Camila Ventura

The ocular findings are seen in up to 55% of affected infants, according to research by Ventura and colleagues, who also associated trimester of infection as well as infant head circumference with likelihood of manifesting ocular abnormalities.

In babies, Zika virus affects the retina, optic nerve and retinal vessels. Macular scarring and focal pigmentary retinal mottling are defining features in the syndrome. Other defining features include severe microcephaly with partially collapsed skull, brain abnormalities (thin cerebral cortices and subcortical calcification), congenital contractures including arthrogryposis and clubfoot, and early hypertonia and symptoms of extrapyramidal involvement.

“In the retina we can see a chorioretinal atrophy that is very well defined and usually found in the macular region,” Ventura said. Pigmentary changes can be associated with the chorioretinal atrophy.

Optic nerve findings include hypoplasia, pallor and increased optic disc cupping.

Regarding vasculature changes, there is a “broad spectrum of findings,” Ventura said, including attenuation, hemorrhages and peripheral alterations.

Other reported ocular findings in smaller numbers include iris coloboma, lens subluxation, glaucoma, cataract and microphthalmia.

In infected adults, ocular findings can include hypertensive anterior uveitis, unilateral acute maculopathy and bilateral posterior uveitis with acquired chorioretinal lesions, she said. – by Patricia Nale, ELS

Reference:

Ventura C. Zika virus and the eye. Presented at: American Society of Cataract and Refractive Surgery annual meeting; May 5-9, 2017; Los Angeles.

Ventura C, et al. J AAPOS. 2017; doi: 10.1016/j.jaapos.2017.04.003.

Disclosure: Ventura reports no relevant financial disclosures.