Major Article
Visual impairment evaluation in 119 children with congenital Zika syndrome

https://doi.org/10.1016/j.jaapos.2018.01.009Get rights and content

Purpose

To assess visual impairment in a large sample of infants with congenital Zika syndrome (CZS) and to compare with a control group using the same assessment protocol.

Methods

The study group was composed of infants with confirmed diagnosis of CZS. Controls were healthy infants matched for age, sex, and socioeconomic status. All infants underwent comprehensive ophthalmologic evaluation including visual acuity, visual function assessment, and visual developmental milestones.

Results

The CZS group included 119 infants; the control group, 85 infants. At examination, the mean age of the CZS group was 8.5 ± 1.2 months (range, 6-13 months); of the controls, 8.4 ± 1.8 months (range, 5-12 months; P = 0.598). Binocular Teller Acuity Card (TAC) testing was abnormal in 107 CZS infants and in 4 controls (89.9% versus 5% [P < 0.001]). In the study group, abnormal monocular TAC results were more frequent in eyes with funduscopic alterations (P = 0.008); however, 104 of 123 structurally normal eyes (84.6%) also presented abnormal TAC results. Binocular contrast sensitivity was reduced in 87 of 107 CZS infants and in 8 of 80 controls (81.3% versus 10% [P < 0.001]). The visual development milestones were less achieved by infants with CZS compared to controls (P < 0.001).

Conclusions

Infants with CZS present with severe visual impairment. A protocol for assessment of the ocular findings, visual acuity, and visual developmental milestones tested against age-matched controls is suggested.

Section snippets

Subjects and Methods

This cross-sectional study received approval from the Institutional Review Board in Recife, Brazil, and followed the tenets of the Declaration of Helsinki. Parents of the infants provided written informed consent before they were enrolled.

The study group included infants born between May and December 2015 in the state of Pernambuco, Brazil, with laboratory confirmation of ZIKV infection, and being treated in a Rehabilitation Center in Recife, Pernambuco. The method used to confirm ZIKV

Results

A total of 119 infants with CZS and 85 healthy controls were enrolled. The mean age at examination of the study group infants was 8.5 ± 1.2 months (range, 6-13 months); of the controls, 8.4 ± 1.8 months (range, 5-12 months; P = 0.598). The mean gestational age at birth in the CZS group was 38.1 ± 2.0 weeks (range, 31-42 weeks). This information was not available for the control group. In the CZS group, 100/113 (89%) infants presented with microcephaly at birth, of which 73/100 (73.0%) presented

Discussion

Children with primary neurological injuries are at risk for visual impairment when deprived of appropriate visual stimuli during the critical period of neuroplasticity.24, 25 Because of the wide spectrum of brain damage and ocular abnormalities, early visual assessment and intervention for infants with CZS is crucial, because vision significantly affects global development.22 This study assessed visual impairment in 119 infants with CZS, expanding previous data collection in a larger sample

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    © 2018 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.