OCT of Retinal Lesions in Infants with Congenital Zika Syndrome

MedicalResearch.com Interview with:
Camila Ventura MD
Pediatric Retina Research Fellow at Bascom Palmer Eye Institute (BPEI), USA
PhD student at Federal University of São Paulo (Unifesp)
Medical Retina, Ocular Oncology, and Uveitis Department at Altino Ventura Foundation Brazil

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Brazilian outbreak of Zika virus (ZIKV) began in April 2015 and since then, we have not been able to stop its rapid spread throughout the Americas. Not only has ZIKV been disseminating very rapidly, patients affected by the ZIKV have also been presenting with some findings never before reported in the literature. Until recently, ZIKV infection was only associated with mild symptoms such as headache, rash, arthralgia, and conjunctivitis. However, in October 2015, a twenty-fold increase in the prevalence of newborns with microcephaly was reported that was later confirmed to be associated to ZIKV infection during pregnancy.

Although microcephaly and other central nervous system findings were the first abnormalities reported, recent publications have described other malformations associated with ZIKV congenital infection including hearing loss, limb anomalies and ocular findings. Due to all of these systemic findings, this new clinical condition has been named Congenital Zika Syndrome (CZS).

In January 2016, our group published the first report on the ocular findings of infants with microcephaly and presumed congenital ZIKV infection, followed by another manuscript describing 10 additional cases. We have also contributed with an article published in JAMA Ophthalmology reporting the risk factors associated to the ocular findings in babies with CZS. Other authors such as De Paula Freitas et al and Miranda 2nd et al, have also contributed to the literature by describing similar ocular findings in these infants with CZS.

In the present case series, we describe the Ocular Coherence Tomography (OCT) findings in ten eyes of eight infants with CZS.

MedicalResearch.com: What should readers take away from your report?

Response: This is the first report that has analyzed the structural changes in the retina and choroid caused by ZIKV in babies. We have observed that depending on the severity of the chorioretinal scar, the outer retinal layers can be affected alone or in more severe cases, the inner retinal layers can also be affected. Although these OCT findings add new information to our knowledge concerning this new congenital infection, it is important to mention that they are not unique to ZIKV infection, therefore this exam cannot be used to differentiate ZIKV from other congenital infections such as Toxoplasmosis.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The next step is to examine ocular tissue of affected eyes in ocular pathology labs. Although OCT has given us more information about the structural changes in the retina and choroid, the examination of the ocular tissue is necessary to correlate the OCT findings with pathology.

MedicalResearch.com: Is there anything else you would like to add?

Response: Our team also believes that it is essential to address vision in these babies. We predict that babies with chorioretinal scars are more visually impaired than those without ocular findings. However, since most present with severe neurological abnormalities, this can play an important role in the visual development of these babies. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

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. Published online November 10, 2016. doi:10.1001/jamaophthalmol.2016.4283

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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