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BACKGROUND AND OBJECTIVE: To evaluate the retinal and vasculature changes in infants with congenital Zika syndrome (CZS) using fluorescein angiography (FA). PATIENTS AND METHODS: This consecutive case series included six infants with CZS. FA and color fundus imaging were performed under general anesthesia in both eyes of all infants using a contact widefield digital imaging system. All color fundus images were obtained using a 130° field of view lens, and the FA images were captured using either a 130° or 80° field of view lens. The immunoglobulin M antibody capture enzyme-linked immunosorbent assay was positive for Zika virus in the cerebrospinal fluid samples of all infants. Other congenital infections were ruled out. RESULTS: The mean ± standard deviation age of the infants at the time of examination was 1.4 years ± 0.1 years (range: 1.3 years to 1.5 years). Contact fundus photographs showed macular abnormalities in seven eyes (58%) and retinal vasculature changes in two eyes (17%). FA detected macular abnormalities in all 12 eyes (100%) and retinal vasculature changes in five eyes (42%). The main retinal vasculature changes were peripheral avascularity in five eyes (42%) and microvasculature abnormalities in three eyes (25%). CONCLUSION: FA may be an important tool for detecting subtle macular and retinal vasculature changes in CZS. [ Ophthalmic Surg Lasers Imaging Retina. 2019;50:702–708.]

Purpose: To evaluate the surgical and functional outcomes in children with congenital Zika syndrome who underwent strabismus surgery. Methods: This prospective case series included children with congenital Zika syndrome who presented with horizontal infantile strabismus and underwent strabismus surgery. Ocular motility and visual fields were assessed preoperatively and postoperatively. Visual fields were considered normal if they exceeded 70 degrees in the temporal meridian. Postoperatively, parents and caregivers answered a questionnaire that assessed their child's behavioral improvements. A final ocular alignment within ±10 prism diopters (PD) and expansion of the visual fields were considered satisfactory motor surgical results at 6 months postoperatively. Results: Five children (3 girls [60%]) with congenital Zika syndrome (age: 36.4 ± 0.9 months) were included in this study. All children (100%) presented with moderate to severe visual impairment and 4 (80%) presented with funduscopic abnormalities. Preoperatively, 4 children (80%) had infantile esotropia (mean preoperative angle of deviation: 41.3 ± 6.3 PD) and 1 (20%) had infantile exotropia measuring 65 PD. The postoperative outcomes demonstrated ocular alignment in 4 children (80%) at the 6-month follow-up visit. Expansion of the temporal visual field was observed in 7 eyes (70%) of 4 children (80%). Four caregivers (80%) reported behavioral improvement in daily activities, and all caregivers (100%) reported improved peripheral target detection and socialization skills. Conclusions: Strabismus surgery can be an effective procedure for treating horizontal strabismus in children with congenital Zika syndrome because it can improve ocular alignment, expand the visual field, and improve the child's social, functional, and behavioral skills. [ J Pediatr Ophthalmol Strabismus . 2020;57(3):169–175.]

O vírus da zika (ZIKV), que anteriormente se limitava a casos esporádicos na África e na Ásia, com sintomas similares a uma gripe leve ou subclínica, rapidamente tomou conta das Américas desde 2015 e passou a ter comprovadamente uma relação com microcefalia e outros defeitos congênitos. O amplo espectro das consequências causadas pela infecção intrauterina do feto por ZIKV foi descrito como síndrome congênita do vírus da zika (CZS). Um dos principais pilares desta nova entidade são as manifestações oculares que os recém-nascidos afetados podem apresentar. Curiosamente, todas as crianças com CZS apresentam comprometimento visual significativo, independentemente de apresentarem achados oculares, o que sugere deficiência visual cortical. Além disso, as crianças com CZS podem ter um poder limitado de acomodação, má acuidade visual, altos erros de refração e estrabismo, requerendo frequentemente correção refrativa. Desta forma, a CZS é um desafio não só para as famílias, mas também para os prestadores de cuidados da saúde e para o sistema de saúde pública. ABSTRACTThe emergence of Zika virus (ZIKV), which was previously limited to sporadic cases in Africa and Asia, with subclinical or mild influenza-like illness, has rapidly become widespread in the Americas since 2015, exhibiting a relationship with microcephaly and other birth defects. The broad spectrum of adverse outcomes caused by ZIKV infection in utero has been described as congenital Zika syndrome (CZS). One of the important pillars of this new entity is the ocular manifestations that may be presented at birth by the affected newborns. Interestingly, all infants with CZS show significant visual impairment, regardless of whether they present with ocular findings, which suggests cortical visual impairment. In addition, infants with CZS may have limited power of accommodation, poor visual acuity, high refractive errors, and strabismus, which frequently require refractive correction. Thus, CZS is a challenge not only to families but also to health care providers and the public health system. Palavras-chave: RESUMENEl virus del zika (ZIKV), que previamente se limitaba a casos esporádicos en África y Asia, con síntomas similares a los de una gripe sencilla o subclínica, rápidamente tomó las Américas desde 2015 y se comprobó la relación que pasó a tener con la microcefalia y otros defectos congénitos. El amplio espectro de las consecuencias provocadas por la infección intrauterina del feto por el ZIKV fue descrito como síndrome congénito por el virus del zika (CZS). Uno de los principales pilares de esta nueva entidad son las manifestaciones oculares que los recién nacidos afectados pueden presentar. Lo curioso es que todos los niños infectados por el CZS presentan problemas visuales significativos, ya sea si presentan hallados oculares o no, lo que sugiere deficiencia visual cortical. Además, los niños infectados por el CZS pueden tener un poder limitado de acomodación, mala acuidad visual, elevadores errores de refracción y estrabismo, por lo cual se requiere cor...