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Andrea Zin, Julia Rosseto, Irena Tsui, Olivia Zin, Joel Silveira, Zilton Vasconcelos, Maria Elisabeth Lopes Moreira; Prescription of overplus of +3.00 D to Infants with Severe Visual Impairment due to Congenital Zika Virus Syndrome. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4673.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Zika virus (ZIKV) has spread to several countries in the Americas, since the first reports from Brazil. Microcephaly, central nervous system, and eye abnormalities have been associated with ZIKV infection as a result of perinatal transmission and can impact visual development. We performed a prospective clinical study to evaluate the role of overplus prescription in improving visual function in infants with severe visual impairment due to congenital ZIKV infection.
Methods: We enrolled infants whose mothers had blood or urine specimens confirmed for ZIKV by reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays. Genetic diseases and other prenatal infectious diseases (i.e. rubella, cytomegalovirus, toxoplasmosis, and syphilis) were ruled out serologically. Detailed demographic, medical, and prenatal history information, as well as clinical findings were documented. Complete clinical examination, intra-cranial ultrasound, neurologic examination were also performed. External ocular examination, visual behavior, motility evaluation, as well as indirect ophthalmoscopy, were performed in all subjects. Cycloplegic refraction with phenylephrine 2.5% and tropicamide 1% was performed at a minimum 3 months of age. Assessment of visual behavior included evaluation of the ability to perceive light, human face, fix and follow objects. Those unable to fix and follow were considered at high risk of low visual development and eligible for overplus of +3.00D prescription after 3 months of age and reassessed 3 months later.
Results: Two hundred and six infants with suspected congenital ZIKV born between October 2015 and July 2016 were examined. ZIKV infection during pregnancy was confirmed by mother’s blood or urine RT- PCR in 91 patients. Forty eight (48%) were female. Of the 91, 64 had central nervous system (CNS) disorders; 14 had microcephaly and 18 had eye abnormalities. At 3 months, 7/91 were unable to fix and follow of which 6 had nystagmus and all 7 had severe CNS abnormalities. After 3 months of +3.00D overplus glasses, fix and follow was seen in 6 of the 7 patients.
Conclusion: Infants exposed to ZIKV prenatal infection are at risk of developing low vision from a combination of CNS and ocular abnormalities. Overplus correction with +3.00D after 3 months of age may compensate for loss of accommodation in infants with congenital ZIKV.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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