Zin Andrea A, Tsui Irena, Rossetto Julia D, Gaw Stephanie L, Neves Luiza M, Zin Olivia A, Haefeli Lorena, Barros Silveira Filho Joel Carlos, Adachi Kristina, Vinicius da Silva Pone Marcos, Pone Sheila Moura, Molleri Natalia, Pereira Jose Paulo, Belfort Rubens, Arumugaswami Vaithilingaraja, Vasconcelos Zilton, Brasil Patricia, Nielsen-Saines Karin, Lopes Moreira Maria Elisabeth
Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira- Fundação Oswaldo Cruz, Rio de Janeiro.
University of California Los Angeles, Los Angeles, California.
J AAPOS. 2018 Dec;22(6):452-456.e1. doi: 10.1016/j.jaapos.2018.07.352. Epub 2018 Oct 22.
To report the findings of a cross-sectional study of visual function in infants with confirmed or suspected antenatal Zika virus (ZIKV) infection seen at a single referral center in Rio de Janeiro.
Infants were examined following the ZIKV outbreak period at Instituto Fernandes Figueira/FIOCRUZ. Visual function was considered abnormal if an infant could not fix and follow a standardized high-contrast target (10 cm) by 3-6 months of age. Visual function and associations with structural eye abnormalities, central nervous system (CNS) abnormalities, microcephaly, and nystagmus were assessed. Sensitivity and specificity of screening criteria for structural eye abnormalities was assessed.
A total of 173 infants met inclusion criteria. Abnormal visual function was found in 52 infants (30.0%) and was significantly associated with eye abnormalities (40/52; OR = 44.2; 95% CI, 16.6-117.6), CNS abnormalities (50/52; OR = 64.0; 95% CI, 14.7-277.6), microcephaly (44/52; OR = 31.5; 95% CI, 12.7-77.8), and nystagmus (26/52; OR = 120.0; 95% CI, 15.6-924.5). Using microcephaly as screening criteria for the detection of eye abnormalities provided a sensitivity of 88.9% (95% CI, 76.0-96.3) and specificity of 82.8% (95% CI, 75.1-88.9). Using both abnormal visual function and microcephaly increased sensitivity to 100% (95% CI, 92.1-100.0) and decreased specificity to 80.5% (95% CI, 72.5-86.9).
Infants with suspected antenatal ZIKV infection and reduced visual function should be referred to an ophthalmologist. Visual function assessments are helpful in screening for antenatal ZIKV exposure in resource-limited settings and can identify infants who may benefit from visual habilitation.
报告在里约热内卢一家转诊中心对确诊或疑似产前感染寨卡病毒（ZIKV）的婴儿进行的视觉功能横断面研究结果。
在费尔南德斯·菲格雷拉研究所/巴西奥斯瓦尔多·克鲁兹基金会寨卡病毒疫情爆发后对婴儿进行检查。如果婴儿在3至6个月大时不能注视并追踪标准化高对比度目标（10厘米），则认为视觉功能异常。评估视觉功能及其与眼部结构异常、中枢神经系统（CNS）异常、小头畸形和眼球震颤的关联。评估眼部结构异常筛查标准的敏感性和特异性。
共有173名婴儿符合纳入标准。52名婴儿（30.0%）存在视觉功能异常，且与眼部异常（40/52；OR = 44.2；95% CI，16.6 - 117.6）、CNS异常（50/52；OR = 64.0；95% CI，14.7 - 277.6）、小头畸形（44/52；OR = 31.5；95% CI，12.7 - 77.8）和眼球震颤（26/52；OR = 120.0；95% CI，15.6 - 924.5）显著相关。以小头畸形作为检测眼部异常的筛查标准，敏感性为88.9%（95% CI，76.0 - 96.3），特异性为82.8%（95% CI，75.1 - 88.9）。同时使用视觉功能异常和小头畸形可将敏感性提高到100%（95% CI，92.1 - 100.0），但特异性降至80.5%（95% CI，72.5 - 86.9）。
疑似产前感染寨卡病毒且视觉功能减退的婴儿应转诊至眼科医生处。视觉功能评估有助于在资源有限的环境中筛查产前寨卡病毒暴露情况，并可识别可能从视觉康复中受益的婴儿。
