Eyeworld

EW NEWS & OPINION 33 Dr. Maia said that future re- search could explore whether or not babies with microcephaly born to mothers infected with Zika show signs of fundus lesions. The evidence is very strong that there is a relationship between the virus itself or even the micro- cephaly and these types of lesions, he said, but this is only the begin- ning of research. With future study, was evidence of ocular abnormalities in the cases of Zika virus exposure, and it was recommended that eval- uations be performed on newborns in regions where the Zika virus is present to identify and treat these issues early on. Analysis on the patients was conducted from December 1 to De- cember 21, 2015 in Salvador, Brazil. Included in the study were infants with cephalic circumference of 32 cm or less at birth. Some other con- genital infections were included in the differential diagnosis. Symptoms of the mothers during pregnancy were also taken into account. Infants were excluded from the study if they had a cephalic diameter that exceed- ed 33 cm, had evidence of certain types of congenital infections, had a family history of microcephaly, or if the mother had a history of alcohol or drug use during pregnancy. Ocular examinations were conducted, with infants undergoing an external ocular examination and indirect ophthalmoscopy and the mother undergoing an external ocu- lar examination, biomicroscopy, and dilated indirect ophthalmoscopy. Any abnormalities were documented at this time. Initially, 31 infants were found to have a confirmed diagnosis of microcephaly, but 2 were excluded. Of the 29 confirmed with micro- cephaly, 23 of the mothers had signs and symptoms of Zika virus during pregnancy. Additionally, the study noted that 10 of the 29 patients with microcephaly had observed ocular abnormalities (34.5%). These ocular issues included focal pigment mottling and chorioretinal atrophy. "The lesions may decrease the vision of these babies," Dr. Maia said, and he estimated that the lesions could be found in 25–35% of babies with microcephaly infected by Zika. One issue with identifying these children at risk ahead of time, he said, is that the mothers may not show symptoms ahead of time. Dr. Maia discussed the 4 major lesions seen in these eyes with EyeWorld. The first, and most frequent, he said, is chorioretinal atrophy located in the macula, espe- cially at the fovea. Another problem could be optic nerve abnormalities related to microcephaly, which could include a pale optic nerve, rings around the optic disc, and no evidence of a high IOP. Chorio- retinal atrophy outside the retina is also a potential problem, as is mottling at the macula, which could be associated with photoreceptor abnormalities. researchers will be able to under- stand it better to be sure about the rates of those infected and who have these lesions. "The fundus lesions are very different, and we are convinced that they are related to the Zika virus infections in these babies with microcephaly," he said. EW FORWARD. Direction. Force. Momentum. 840 Walnut Street Philadelphia, PA 19107 www.willseye.org 1-877-AT-WILLS A world-class institution grows By doing the right things And moving all of us forward. Reference 1. de Paula Freitas B, et al. Ocular findings in infants with microcephaly associated with presumed Zika virus congenital infection in Salvador, Brazil. JAMA Ophthalmol. 2016 Feb 9. [Epub ahead of print] Editors' note: Dr. Maia has no financial interests related to this article. Contact information Maia: maiamauricio@terra.com.br March 2016 Zika continued from page 30

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