Wednesday, May 25, 2016

Brazil: Expanded Spectrum of Congenital Ocular Findings in Microcephaly

Credit CDC



As mentioned previously, while microcephaly has gotten the most attention, the full spectrum of congenital defects caused by maternal infection with the Zika virus isn't known.  

There may well be subtle learning disabilities, or other physical impairments, that won't show up for years.  

But one area that has already been noted are congenital ocular malformations (see PAHO: Epidemiological Update On Zika - Jan 17th). In March we looked at a study that found a plausible mechanism of infection that could produce both brain and eye abnormalities (see AXL as a Candidate Zika Virus Entry Receptor).

Today we've a new (admittedly small & observational) study, appearing in the Journal Opthalmology, that reports on finding additional types of serious eye abnormalities in three microcephalic children born in Brazil, with suspected maternal Zika virus infection.

I've only included a small excerpt, so follow the link below to read the full report.

Manuscript no. 2016-209.


Three male infants born in northern Brazil whose mothers demonstrated a viral syndrome during the first trimester and who subsequently were born with microcephaly.


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).


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.

The American Academy of Ophthalmology has produced a press release, where they discuss these findings and their intention to revise their clinical statement on  the Zika virus based on these findings.

Ophthalmologists find retinal bleeding, abnormal blood vessel development and lesions in infants born to mothers who showed signs of the viral infection during pregnancy

American Academy of Ophthalmology

SAN FRANCISCO - May 25, 2016 - Researchers studying babies with a Zika virus-related birth defect say they have found previously unreported eye problems possibly linked to the virus that could result in severe visual impairment. In three Brazilian infants with microcephaly, the researchers observed retinal lesions, hemorrhaging and abnormal blood vessel development not noted before in relation to the virus. The findings are being published online today in Ophthalmology, journal of the American Academy of Ophthalmology. 


"To my knowledge, the eye problems we found have not been associated with Zika virus before," said Darius Moshfeghi, M.D., senior author and a professor of ophthalmology at the Stanford University School of Medicine. "The next step is to differentiate what findings are related to the Zika virus itself versus microcephaly caused by the virus in order to better understand which infants will need screening." 

For now, the authors are calling for all babies with microcephaly in areas hit by Zika to be examined by an ophthalmologist. This is consistent with recent screening recommendations made by the Centers for Disease Control and Prevention. 

"Until further notice, health professionals in regions endemic for Zika infection are advised to submit all newborns with microcephaly to retinal examinations," the authors wrote. "The procedure can contribute significantly to our understanding of the infection." 

(Continue . . . )

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