IMPORTANCE The Zika virus (ZIKV) might cause microcephaly and ophthalmoscopic findings in infants of mothers infected during pregnancy. OBJECTIVE To assess and identify possible risk factors for ophthalmoscopic findings in infants born with microcephaly and a presumed clinical diagnosis of ZIKV intrauterine infection. DESIGN, SETTING, AND PARTICIPANTS We conducted a cross-sectional study at the Altino Ventura Foundation in Recife, Brazil, that included 40 infants with microcephaly born in Pernambuco state, Brazil, between May and December 2015. Toxoplasmosis, rubella, cytomegalovirus, syphilis, and human immunodeficiency virus were ruled out in all of them. Testing of cerebrospinal fluid for ZIKV using IgM antibody-capture enzyme-linked immunosorbent assay was performed in 24 of 40 infants (60.0%). The infants and mothers underwent ocular examinations. The infants were divided into 2 groups, those with and without ophthalmoscopic alterations, for comparison. MAIN OUTCOMES AND MEASURES Identification of risk factors for ophthalmoscopic findings in infants born with microcephaly and ZIKV intrauterine infection. RESULTS Among the 40 infants, the mean (SD) age was 2.2 (1.2) months (range, 0.1-7.3 months). Of the 24 infants tested, 100% had positive results for ZIKV infection: 14 of 22 infants (63.6%) from the group with ophthalmoscopic findings and 10 of 18 infants (55.6%) from the group without ophthalmoscopic findings. The major symptoms reported in both groups were rash by 26 mothers (65.0%), fever by 9 mothers (22.5%), headache by 9 mothers (22.5%), and arthralgia by 8 mothers (20.0%). No mothers reported conjunctivitis or other ocular symptoms during pregnancy or presented signs of uveitis at the time of examination. Thirty-seven eyes (46.3%) of 22 infants (55.0%) had ophthalmoscopic alterations. Ten mothers (71.4%) of infants with ocular findings reported symptoms during the first trimester (frequency, 0.48; 95% CI, 0.02-0.67; P = .04). A difference was also observed between the groups of infants with and without ocular findings regarding the cephalic perimeter: mean (SD) of 28.8 (1.7) and 30.3 (1.5), respectively (frequency, −1.50; 95% CI, −2.56 to −0.51; P = .004). CONCLUSIONS AND RELEVANCE Ocular involvement in infants with presumed ZIKV congenital infection were more often seen in infants with smaller cephalic diameter at birth and in infants whose mothers reported symptoms during the first trimester.

Objetivo: Apresentar os dados obtidos de programa baseado na triagem visual de recém-nascidos, realizado em três maternidades públicas de referência do estado de Pernambuco, Brasil. Métodos: O projeto foi desenvolvido de forma prospectiva seguindo protocolo e organograma previamente elaborados. Para a sua execução contou-se com equipe multidisciplinar composta de 37 profissionais. Realizou-se a capacitação da equipe envolvida no projeto e ministrou-se palestras em cada maternidade, para os oftalmologistas, diretores, pediatras, neonatologistas, obstetras e enfermeiras. Os exames oftalmológicos foram realizados nas próprias maternidades públicas, com encaminhamento e tratamento dos casos de maior complexidade na sede da Fundação Altino Ventura. Pesquisou-se a flora conjuntival do recém-nascido e a vaginal materna, em 25 casos. Resultados: Capacitaram-se 20 oftalmologistas para o exame dos recém-nascidos. Examinaram-se 3.280 recém-nascidos (1.601 femininos e 1.679 masculinos). Foi detectado alguma anormalidade ocular ou fatores de risco em 701 casos (21,4%). A anormalidade ocular mais freqüente foi a hemorragia retiniana, vista em 255 casos (7,8%). O fator de risco para doença ocular de maior prevalência foi a retinopatia da prematuridade, detectada em 325 casos (9,9%), que foram encaminhados ao serviço especializado. Dos casos encaminhados, compareceram 65 pacientes (20,0%), e destes, em 15 casos (23,1%) havia algum grau de retinopatia da prematuridade. Na pesquisa, quanto à flora conjuntival do recém-nascido (50 olhos), 13 olhos (26,0%) apresentaram pelo menos um microrganismo. Em 18 casos de mães com cultura vaginal positiva para Staphylococcus epidermides, 10 (40,0%) apresentaram filho com a mesma bactéria em um ou ambos os olhos. Conclusões: Os autores enfatizam o pioneirismo do projeto, ressalvando que possibilitou maior interação entre oftalmologistas e profissionais de áreas afins, treinamento de oftalmologistas para o exame ocular nos recém-nascidos, permitindo a obtenção de importantes informações quanto às morbidades oculares da região, promovendo o adequado tratamento e seguimento dos casos indicados em idade precoce.

Children with multiple handicaps need an early ophthalmologic diagnosis and treatment for better global development. The integration of a multidisciplinary team with pediatricians, pediatric ophthalmologists and specialists in low vision, may assure a better visual rehabilitation.

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.]