Glaucoma Workup in Congenital Zika Syndrome

Abstract

Purpose: The main aim of this study was to perform a glaucoma workup in infants with congenital Zika syndrome (CZS). Patient and Methods: This cross-sectional study included 188 eyes of 107 children (1.1±0.3 y; range, 0.3 to 1.8 y) with CZS. The confirmation of the syndrome was possible in 77 of 107 (72.0%) of the enrolled infants based on positive immunoglobulin M antibody capture enzyme-linked immunosorbent assay for Zika virus in the cerebrospinal fluid. All infants underwent a complete ophthalmic examination and bilateral fundus imaging was captured using a wide-angle digital fundus camera (RetCam). Results: Five eyes (2.6%) presented 2 criteria for glaucoma diagnosis: 1 eye (0.5%) presented increased intraocular pressure and increased vertical cup-to-disc ratio (CDR); 3 eyes (1.6%) presented increased horizontal corneal diameter and increased vertical, and 1 eye (0.5%) presented myopia related to increased axial length and increased vertical CDR. When excluding the CDR criterion, there was no case of glaucoma in this sample. A significant correlation was observed between high vertical CDR and small cephalic perimeter at birth (P=0.002) and the presence of clinical macular lesions (P=0.031). Conclusion and Relevance: Although childhood glaucoma was not detected in this sample, increased vertical CDR is present in children with CZS, associated with microcephaly and clinical macular lesions at birth. This finding may lead to a misdiagnosis of glaucoma.

Color Fundus Imaging Using a High-Magnification Lens for Detecting Subtle Macular Changes in Infants With Congenital Zika Syndrome

“…[2][3][4][5][6][7][8] Although anterior segment and structural ocular findings such as congenital glaucoma, congenital cataract, microphthalmia, iris coloboma, and lens subluxation can also be found, because of the ZIKV's neurotropism, the ophthalmologic manifestations of congenital Zika syndrome (CZS) are observed mostly in the posterior segment of the eye. [2][3][4][5][6][7][8][9][10][11][12] Among these findings, the typical manifestations are chorioretinal atrophy and focal pigment mottling in the macular region. [1][2][3][4] In addition, optic nerve findings (eg, optic nerve hypoplasia, increased cup-to-disc ratio, and pallor) and retinal vasculature alterations (eg, peripheral avascularity, vascular attenuation, and hemorrhages) can also be found.…”

“…[1][2][3][4] In addition, optic nerve findings (eg, optic nerve hypoplasia, increased cup-to-disc ratio, and pallor) and retinal vasculature alterations (eg, peripheral avascularity, vascular attenuation, and hemorrhages) can also be found. 4,7,[9][10][11][12] Digital retinal imaging was initially proposed for retinopathy of prematurity screening but has been widely used for pediatric retinal disease documentation. 13,14 Portable digital retinal cameras are commercially available and can be categorized as wide-angle cameras or narrow-angle cameras.…”