What are the optical coherence tomographic (OCT) findings in infants with congenital Zika syndrome who present with chorioretinal scars?
In this case series of 8 infants with congenital Zika syndrome and associated retinal abnormalities who were born in Pernambuco, Brazil, OCT imaging performed in 9 of the 16 eyes, of which 8 were affected, showed substantial neurosensory retinal thinning with discontinuation of the ellipsoid zone, choroidal thinning, and hyperreflectivity underlying areas of presumed atrophic retinal pigment epithelium.
Zika virus can cause substantial damage to the retina, including the internal and external layers, and the choroid.
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.
To evaluate the affected retinal layers in infants with CZS and associated retinal abnormalities using optical coherence tomography (OCT).
Design, Setting, and Participants
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.
Main Outcomes and Measures
Observation of retinal and choroidal findings in the OCT images.
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 and Relevance
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.
Ventura CV, Ventura LO, Bravo-Filho V, Martins TT, Berrocal AM, Gois AL, de Oliveira Dias JR, Araújo L, Escarião P, van der Linden V, Belfort R, Maia M. Optical Coherence Tomography of Retinal Lesions in Infants With Congenital Zika Syndrome. JAMA Ophthalmol. 2016;134(12):1420-1427. doi:10.1001/jamaophthalmol.2016.4283