Ventura Camila V, Ventura Liana O, Bravo-Filho Vasco, Martins Thayze T, Berrocal Audina M, Gois Adriana L, de Oliveira Dias João Rafael, Araújo Leandro, Escarião Paulo, van der Linden Vanessa, Belfort Rubens, Maia Mauricio
Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil3Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil4Bascom Palmer Eye Institute, Miami, Florida.
Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil.
JAMA Ophthalmol. 2016 Dec 1;134(12):1420-1427. doi: 10.1001/jamaophthalmol.2016.4283.
Zika virus (ZIKV) can cause severe changes in the retina and choroid that may result in marked visual impairment in infants with congenital Zika syndrome (CZS), the term created for a variety of anomalies associated with intrauterine ZIKV infection.
To evaluate the affected retinal layers in infants with CZS and associated retinal abnormalities using optical coherence tomography (OCT).
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional, consecutive case series included 8 infants (age range, 3.0-5.1 months) with CZS. Optical coherence tomographic images were obtained in the affected eyes of 7 infants with CZS who had undergone previous ophthalmologic examinations on March 17, 2016, and in 1 infant on January 1, 2016. An IgM antibody-capture enzyme-linked immunosorbent assay for ZIKV was performed on the cerebrospinal fluid samples of 7 of the 8 infants (88%), and other congenital infections were ruled out.
Observation of retinal and choroidal findings in the OCT images.
Among the 8 infants included in the study (3 male; 5 female; mean [SD] age at examination, 4.1 [0.7] months), 7 who underwent cerebrospinal fluid analysis for ZIKV had positive findings for IgM antibodies. Eleven of the 16 eyes (69%) of the 8 infants had retinal alterations and OCT imaging was performed in 9 (82%) of them. Optical coherence tomography was also performed in 1 unaffected eye. The main OCT findings in the affected eyes included discontinuation of the ellipsoid zone and hyperreflectivity underlying the retinal pigment epithelium in 9 eyes (100%), retinal thinning in 8 eyes (89%), choroidal thinning in 7 eyes (78%), and colobomatouslike excavation involving the neurosensory retina, retinal pigment epithelium, and choroid in 4 eyes (44%).
Zika virus can cause severe damage to the retina, including the internal and external layers, and the choroid. The colobomatouslike finding seen in the OCT images relate to the excavated chorioretinal scar observed clinically.
寨卡病毒（ZIKV）可导致视网膜和脉络膜发生严重变化，这可能会使患有先天性寨卡综合征（CZS）的婴儿出现明显视力损害，CZS这一术语是为与子宫内ZIKV感染相关的多种异常情况而设立的。
使用光学相干断层扫描（OCT）评估患有CZS及相关视网膜异常的婴儿中受影响的视网膜层。
设计、地点和参与者：本横断面连续病例系列研究纳入了8例患有CZS的婴儿（年龄范围为3.0 - 5.1个月）。对7例于2016年3月17日接受过眼科检查的患有CZS的婴儿的患眼以及1例于2016年1月1日接受检查的婴儿的患眼进行了光学相干断层扫描图像采集。对8例婴儿中的7例（88%）的脑脊液样本进行了ZIKV的IgM抗体捕获酶联免疫吸附测定，并排除了其他先天性感染。
观察OCT图像中的视网膜和脉络膜表现。
在纳入研究的8例婴儿中（3例男性；5例女性；检查时的平均[标准差]年龄为4.1[0.7]个月），7例接受ZIKV脑脊液分析的婴儿IgM抗体检测呈阳性。8例婴儿的16只眼中有11只（69%）存在视网膜改变，其中9只（82%）进行了OCT成像。还对1只未受影响的眼睛进行了光学相干断层扫描。患眼中主要的OCT表现包括9只眼（100%）的椭圆体带中断和视网膜色素上皮下方的高反射，8只眼（89%）的视网膜变薄，7只眼（78%）的脉络膜变薄，以及4只眼（44%）的涉及神经感觉视网膜、视网膜色素上皮和脉络膜的类似缺损样凹陷。
寨卡病毒可对视网膜（包括内层和外层）以及脉络膜造成严重损害。OCT图像中所见的类似缺损样表现与临床上观察到的脉络膜视网膜瘢痕凹陷有关。
