Expanded Spectrum of Congenital Ocular Findings in Microcephaly with Presumed Zika Infection

Purpose To describe the ocular findings of 3 cases of suspected congenital Zika viral infection with microcephaly and maculopathy. Design Retrospective, consecutive case series. Participants Three male infants born in northern Brazil whose mothers demonstrated a viral syndrome during the first trime...

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Veröffentlicht in:Ophthalmology (Rochester, Minn.) Minn.), 2016-08, Vol.123 (8), p.1788-1794
Hauptverfasser: Miranda, Homero Augusto de, MD, Costa, Marcelo Cavalcante, MD, Frazão, Maria Auxiliadora Monteiro, MD, Simão, Natália, MD, Franchischini, Sandra, MD, Moshfeghi, Darius M., MD
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container_end_page 1794
container_issue 8
container_start_page 1788
container_title Ophthalmology (Rochester, Minn.)
container_volume 123
creator Miranda, Homero Augusto de, MD
Costa, Marcelo Cavalcante, MD
Frazão, Maria Auxiliadora Monteiro, MD
Simão, Natália, MD
Franchischini, Sandra, MD
Moshfeghi, Darius M., MD
description Purpose To describe the ocular findings of 3 cases of suspected congenital Zika viral infection with microcephaly and maculopathy. Design Retrospective, consecutive case series. Participants Three male infants born in northern Brazil whose mothers demonstrated a viral syndrome during the first trimester and who subsequently were born with microcephaly. Methods Observational report of macular findings. Main Outcome Measures Continued observation. Results Three male infants were born with microcephaly to mothers who had a viral syndrome during the first trimester of gestation in an area that subsequently has demonstrated epidemic Zika infection, a flavivirus related to Dengue. Ocular examination was performed. All 6 eyes demonstrated a pigmentary maculopathy ranging from mild to pronounced. In 4 eyes, well-delineated macular chorioretinal atrophy with a hyperpigmented ring developed. Three eyes demonstrated vascular tortuosity and 2 eyes demonstrated a pronounced early termination of the retinal vasculature on photographic evaluation. Two eyes demonstrated a washed out peripheral retina with a hypolucent spot. One eye had scattered subretinal hemorrhages external to the macula. Finally, 1 eye demonstrated peripheral pigmentary changes and clustered atrophic lesions resembling grouped congenital albinotic spots (polar bear tracks). Conclusions Zika virus has been linked to microcephaly in children of mothers with a viral syndrome during the first trimester of pregnancy. Ocular findings previously described a pigmentary retinopathy and atrophy that now can be expanded to include torpedo maculopathy, vascular changes, and hemorrhagic retinopathy. Ophthalmologic screening guidelines need to be defined to determine which children would benefit from newborn screening in affected regions.
doi_str_mv 10.1016/j.ophtha.2016.05.001
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Design Retrospective, consecutive case series. Participants Three male infants born in northern Brazil whose mothers demonstrated a viral syndrome during the first trimester and who subsequently were born with microcephaly. Methods Observational report of macular findings. Main Outcome Measures Continued observation. Results Three male infants were born with microcephaly to mothers who had a viral syndrome during the first trimester of gestation in an area that subsequently has demonstrated epidemic Zika infection, a flavivirus related to Dengue. Ocular examination was performed. All 6 eyes demonstrated a pigmentary maculopathy ranging from mild to pronounced. In 4 eyes, well-delineated macular chorioretinal atrophy with a hyperpigmented ring developed. Three eyes demonstrated vascular tortuosity and 2 eyes demonstrated a pronounced early termination of the retinal vasculature on photographic evaluation. Two eyes demonstrated a washed out peripheral retina with a hypolucent spot. One eye had scattered subretinal hemorrhages external to the macula. Finally, 1 eye demonstrated peripheral pigmentary changes and clustered atrophic lesions resembling grouped congenital albinotic spots (polar bear tracks). Conclusions Zika virus has been linked to microcephaly in children of mothers with a viral syndrome during the first trimester of pregnancy. Ocular findings previously described a pigmentary retinopathy and atrophy that now can be expanded to include torpedo maculopathy, vascular changes, and hemorrhagic retinopathy. Ophthalmologic screening guidelines need to be defined to determine which children would benefit from newborn screening in affected regions.</description><identifier>ISSN: 0161-6420</identifier><identifier>EISSN: 1549-4713</identifier><identifier>DOI: 10.1016/j.ophtha.2016.05.001</identifier><identifier>PMID: 27236271</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Brazil ; Corneal Dystrophies, Hereditary - diagnosis ; Eye Infections, Viral - diagnosis ; Eye Infections, Viral - virology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Male ; Microcephaly - diagnosis ; Microcephaly - virology ; Ophthalmology ; Pregnancy ; Pregnancy Complications, Infectious - diagnosis ; Pregnancy Complications, Infectious - virology ; Retinal Diseases - diagnosis ; Retinal Diseases - virology ; Retinal Hemorrhage - diagnosis ; Retinal Vessels - pathology ; Retrospective Studies ; Zika Virus Infection - diagnosis ; Zika Virus Infection - virology</subject><ispartof>Ophthalmology (Rochester, Minn.), 2016-08, Vol.123 (8), p.1788-1794</ispartof><rights>American Academy of Ophthalmology</rights><rights>2016 American Academy of Ophthalmology</rights><rights>Copyright © 2016 American Academy of Ophthalmology. 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Design Retrospective, consecutive case series. Participants Three male infants born in northern Brazil whose mothers demonstrated a viral syndrome during the first trimester and who subsequently were born with microcephaly. Methods Observational report of macular findings. Main Outcome Measures Continued observation. Results Three male infants were born with microcephaly to mothers who had a viral syndrome during the first trimester of gestation in an area that subsequently has demonstrated epidemic Zika infection, a flavivirus related to Dengue. Ocular examination was performed. All 6 eyes demonstrated a pigmentary maculopathy ranging from mild to pronounced. In 4 eyes, well-delineated macular chorioretinal atrophy with a hyperpigmented ring developed. Three eyes demonstrated vascular tortuosity and 2 eyes demonstrated a pronounced early termination of the retinal vasculature on photographic evaluation. Two eyes demonstrated a washed out peripheral retina with a hypolucent spot. One eye had scattered subretinal hemorrhages external to the macula. Finally, 1 eye demonstrated peripheral pigmentary changes and clustered atrophic lesions resembling grouped congenital albinotic spots (polar bear tracks). Conclusions Zika virus has been linked to microcephaly in children of mothers with a viral syndrome during the first trimester of pregnancy. Ocular findings previously described a pigmentary retinopathy and atrophy that now can be expanded to include torpedo maculopathy, vascular changes, and hemorrhagic retinopathy. Ophthalmologic screening guidelines need to be defined to determine which children would benefit from newborn screening in affected regions.</description><subject>Brazil</subject><subject>Corneal Dystrophies, Hereditary - diagnosis</subject><subject>Eye Infections, Viral - diagnosis</subject><subject>Eye Infections, Viral - virology</subject><subject>Female</subject><subject>Gestational Age</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Microcephaly - diagnosis</subject><subject>Microcephaly - virology</subject><subject>Ophthalmology</subject><subject>Pregnancy</subject><subject>Pregnancy Complications, Infectious - diagnosis</subject><subject>Pregnancy Complications, Infectious - virology</subject><subject>Retinal Diseases - diagnosis</subject><subject>Retinal Diseases - virology</subject><subject>Retinal Hemorrhage - diagnosis</subject><subject>Retinal Vessels - pathology</subject><subject>Retrospective Studies</subject><subject>Zika Virus Infection - diagnosis</subject><subject>Zika Virus Infection - virology</subject><issn>0161-6420</issn><issn>1549-4713</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUFvEzEQhS0EoqHwDxDykcsuHtuxkwsSilqoVFSkwgUhWbZ3tnG6sRd7F8i_x1EKBy6cRqN580bvG0JeAmuBgXqza9O4nba25bVr2bJlDB6RBSzlupEaxGOyqANolOTsjDwrZccYU0rIp-SMay4U17Ag3y5-jTZ22NHbEf2U5z1NPd2keIcxTHagN34ebKaXIXYh3hUaIv0YfE4ex60dDvRnmLb0U8Yy76vJ13Bv6VXsq1VI8Tl50tuh4IuHek6-XF583nxorm_eX23eXTdegp4aAI220ysuHKhV751T0inVsZ73TqCXfClAWGUZrmHdc3AOaxAPrJPCOS_OyeuT75jT9xnLZPaheBwGGzHNxcCKaaZXwFWVypO0RiglY2_GHPY2Hwwwc-RqdubE1Ry5GrY0lWtde_VwYXY159-lPyCr4O1JgDXnj4DZFB8weuxCrjBMl8L_Lvxr4IcQg7fDPR6w7NKcY2VowBRumLk9_vb4WlCCca3X4jcRlKCB</recordid><startdate>20160801</startdate><enddate>20160801</enddate><creator>Miranda, Homero Augusto de, MD</creator><creator>Costa, Marcelo Cavalcante, MD</creator><creator>Frazão, Maria Auxiliadora Monteiro, MD</creator><creator>Simão, Natália, MD</creator><creator>Franchischini, Sandra, MD</creator><creator>Moshfeghi, Darius M., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160801</creationdate><title>Expanded Spectrum of Congenital Ocular Findings in Microcephaly with Presumed Zika Infection</title><author>Miranda, Homero Augusto de, MD ; Costa, Marcelo Cavalcante, MD ; Frazão, Maria Auxiliadora Monteiro, MD ; Simão, Natália, MD ; Franchischini, Sandra, MD ; Moshfeghi, Darius M., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-117ead7823b168fcbb64b66d0f2fb3ec425313a6a0e919f21bbe663c10d43bbc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Brazil</topic><topic>Corneal Dystrophies, Hereditary - diagnosis</topic><topic>Eye Infections, Viral - diagnosis</topic><topic>Eye Infections, Viral - virology</topic><topic>Female</topic><topic>Gestational Age</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Male</topic><topic>Microcephaly - diagnosis</topic><topic>Microcephaly - virology</topic><topic>Ophthalmology</topic><topic>Pregnancy</topic><topic>Pregnancy Complications, Infectious - diagnosis</topic><topic>Pregnancy Complications, Infectious - virology</topic><topic>Retinal Diseases - diagnosis</topic><topic>Retinal Diseases - virology</topic><topic>Retinal Hemorrhage - diagnosis</topic><topic>Retinal Vessels - pathology</topic><topic>Retrospective Studies</topic><topic>Zika Virus Infection - diagnosis</topic><topic>Zika Virus Infection - virology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Miranda, Homero Augusto de, MD</creatorcontrib><creatorcontrib>Costa, Marcelo Cavalcante, MD</creatorcontrib><creatorcontrib>Frazão, Maria Auxiliadora Monteiro, MD</creatorcontrib><creatorcontrib>Simão, Natália, MD</creatorcontrib><creatorcontrib>Franchischini, Sandra, MD</creatorcontrib><creatorcontrib>Moshfeghi, Darius M., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Ophthalmology (Rochester, Minn.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Miranda, Homero Augusto de, MD</au><au>Costa, Marcelo Cavalcante, MD</au><au>Frazão, Maria Auxiliadora Monteiro, MD</au><au>Simão, Natália, MD</au><au>Franchischini, Sandra, MD</au><au>Moshfeghi, Darius M., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Expanded Spectrum of Congenital Ocular Findings in Microcephaly with Presumed Zika Infection</atitle><jtitle>Ophthalmology (Rochester, Minn.)</jtitle><addtitle>Ophthalmology</addtitle><date>2016-08-01</date><risdate>2016</risdate><volume>123</volume><issue>8</issue><spage>1788</spage><epage>1794</epage><pages>1788-1794</pages><issn>0161-6420</issn><eissn>1549-4713</eissn><abstract>Purpose To describe the ocular findings of 3 cases of suspected congenital Zika viral infection with microcephaly and maculopathy. Design Retrospective, consecutive case series. Participants Three male infants born in northern Brazil whose mothers demonstrated a viral syndrome during the first trimester and who subsequently were born with microcephaly. Methods Observational report of macular findings. Main Outcome Measures Continued observation. Results Three male infants were born with microcephaly to mothers who had a viral syndrome during the first trimester of gestation in an area that subsequently has demonstrated epidemic Zika infection, a flavivirus related to Dengue. Ocular examination was performed. All 6 eyes demonstrated a pigmentary maculopathy ranging from mild to pronounced. In 4 eyes, well-delineated macular chorioretinal atrophy with a hyperpigmented ring developed. Three eyes demonstrated vascular tortuosity and 2 eyes demonstrated a pronounced early termination of the retinal vasculature on photographic evaluation. Two eyes demonstrated a washed out peripheral retina with a hypolucent spot. One eye had scattered subretinal hemorrhages external to the macula. Finally, 1 eye demonstrated peripheral pigmentary changes and clustered atrophic lesions resembling grouped congenital albinotic spots (polar bear tracks). Conclusions Zika virus has been linked to microcephaly in children of mothers with a viral syndrome during the first trimester of pregnancy. Ocular findings previously described a pigmentary retinopathy and atrophy that now can be expanded to include torpedo maculopathy, vascular changes, and hemorrhagic retinopathy. Ophthalmologic screening guidelines need to be defined to determine which children would benefit from newborn screening in affected regions.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27236271</pmid><doi>10.1016/j.ophtha.2016.05.001</doi><tpages>7</tpages></addata></record>
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subjects Brazil
Corneal Dystrophies, Hereditary - diagnosis
Eye Infections, Viral - diagnosis
Eye Infections, Viral - virology
Female
Gestational Age
Humans
Infant, Newborn
Male
Microcephaly - diagnosis
Microcephaly - virology
Ophthalmology
Pregnancy
Pregnancy Complications, Infectious - diagnosis
Pregnancy Complications, Infectious - virology
Retinal Diseases - diagnosis
Retinal Diseases - virology
Retinal Hemorrhage - diagnosis
Retinal Vessels - pathology
Retrospective Studies
Zika Virus Infection - diagnosis
Zika Virus Infection - virology
title Expanded Spectrum of Congenital Ocular Findings in Microcephaly with Presumed Zika Infection
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