Department of Ophthalmology, Centre Hospitalier de Perpignan, Perpignan, France.
Department of Ophthalmology, Centre Hospitalier Universitaire, Guadeloupe, French West Indies.
JAMA Ophthalmol. 2021 Jan 1;139(1):95-102. doi: 10.1001/jamaophthalmol.2020.5131.
Acute anterior uveitis has been reported to be associated with Zika virus (ZIKV) infection in case reports and retrospective studies based on systemic clinical signs of ZIKV and positive serologic tests.
To describe the ophthalmic findings associated with systemic ZIKV infection during the 2016 ZIKV outbreak in Guadeloupe in the French West Indies.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study assessed adult patients with red eye and virologic or serologic confirmation of acute ZIKV infection who were admitted to the Pointe-à-Pitre University Hospital from January 1, 2016, to January 1, 2017, for a systematic ophthalmologic examination. All patients with anterior uveitis also underwent a complete uveitis workup to rule out other causes of uveitis. Patients were excluded from the study if they had active uveitis and a history of uveitis or positive serology for other infectious diseases including dengue fever virus and chikungunya virus. Data were analyzed from January 1, 2016, to January 1, 2017.
Patients with confirmed ZIKV infection underwent full ophthalmic examination at study inception and 3, 6, and 12 months.
Description of the presenting ocular characteristics, management, and outcome.
Of 62 total patients with a red eye, 32 (51.6%) had no uveitis (mean [SD] age, 27.8 [3.7] years; 26 women [81.3%]) and 30 (48.4%) had anterior uveitis (mean [SD] age, 27.5 [3.8] years; 26 women [86.7%]), which was bilateral in all cases. Acute anterior uveitis was nongranulomatous and without synechiae, exhibiting mild anterior chamber reaction with small keratic precipitates. Ocular hypertension occurred in 25 patients (83.3%) with uveitis at presentation and persisted in 15 patients (50%) at 1 year despite antiglaucoma therapy and control of uveitis. Uveitis responded to topical steroids in all cases. Intraocular pressure was within normal limits for all patients without uveitis throughout the follow-up period.
Anterior uveitis was present in almost half of patients with a red eye and acute systemic ZIKV infection; the uveitis was usually bilateral and often associated with increased intraocular pressure. These results suggest that ophthalmic evaluation should be performed in patients with red eye and acute ZIKV infection to potentially detect and manage hypertensive anterior uveitis.
在基于 Zika 病毒（ZIKV）系统临床体征和阳性血清学检测的病例报告和回顾性研究中，有报道称急性前葡萄膜炎与 ZIKV 感染有关。
描述 2016 年 ZIKV 爆发期间法属西印度群岛瓜德罗普岛发生的全身性 ZIKV 感染患者的眼部表现。
设计、设置和参与者：本队列研究评估了因眼部发红且病毒学或血清学证实急性 ZIKV 感染而于 2016 年 1 月 1 日至 2017 年 1 月 1 日期间入住皮特尔角城大学医院的成年患者，所有患有前葡萄膜炎的患者还接受了全面的葡萄膜炎检查以排除其他葡萄膜炎病因。如果患者有活动性葡萄膜炎和葡萄膜炎病史或其他传染病（包括登革热病毒和基孔肯雅热病毒）的阳性血清学，则将患者排除在研究之外。数据于 2016 年 1 月 1 日至 2017 年 1 月 1 日进行分析。
确诊的 ZIKV 感染患者在研究开始时以及 3、6 和 12 个月时接受全面眼部检查。
描述眼部表现特征、治疗和结局。
在 62 例因眼部发红就诊的患者中，32 例（51.6%）无葡萄膜炎（平均[标准差]年龄，27.8[3.7]岁；26 名女性[81.3%]），30 例（48.4%）患有前葡萄膜炎（平均[标准差]年龄，27.5[3.8]岁；26 名女性[86.7%]），所有病例均为双侧。急性前葡萄膜炎为非肉芽肿性且无虹膜后粘连，表现为轻度前房反应伴少量角膜后沉着物。25 例（83.3%）有葡萄膜炎的患者在就诊时出现眼内压升高，尽管进行了抗青光眼治疗和控制葡萄膜炎，但在 1 年时仍有 15 例（50%）患者眼内压持续升高。所有病例的葡萄膜炎均对局部皮质类固醇治疗有反应。在整个随访期间，所有无葡萄膜炎的患者眼内压均在正常范围内。
急性前葡萄膜炎几乎见于一半因急性全身性 ZIKV 感染而出现眼部发红的患者；葡萄膜炎通常为双侧，常伴有眼内压升高。这些结果表明，对于出现眼部发红和急性 ZIKV 感染的患者，应进行眼科评估，以潜在地发现和治疗高血压性前葡萄膜炎。
