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Prog Retin Eye Res. 2018 Sep;66:85-106. doi: 10.1016/j.preteyeres.2018.04.004. Epub 2018 Apr 24.

Zika and the Eye: Pieces of a Puzzle.

Author information

1
Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil.
2
Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil; Altino Ventura Foundation, Recife, Pernambuco, Brazil; HOPE Eye Hospital, Recife, Pernambuco, Brazil.
3
Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil; Department of Ophthalmology, Roberto Santos General Hospital, Salvador, Brazil.
4
Altino Ventura Foundation, Recife, Pernambuco, Brazil; HOPE Eye Hospital, Recife, Pernambuco, Brazil.
5
Scheie Eye Institute at the Perelman Center for Advanced Medicine, Perelman School of Medicine, Department of Ophthalmology, University of Pennsylvania, Philadelphia, United States.
6
Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Salvador, Brazil; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States.
7
Clinical Research Unit, Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
8
Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil; Brazilian Institute of Fight Against Blindness, Assis and Presidente Prudente, São Paulo, Brazil. Electronic address: mmaia@unifesp.br.

Abstract

Zika virus (ZIKV) is an arbovirus mainly transmitted to humans by mosquitoes from Aedes genus. Other ways of transmission include the perinatal and sexual routes, blood transfusion, and laboratory exposure. Although the first human cases were registered in 1952 in African countries, outbreaks were only reported since 2007, when entire Pacific islands were affected. In March 2015, the first cases of ZIKV acute infection were notified in Brazil and, to date, 48 countries and territories in the Americas have confirmed local mosquito-borne transmission of ZIKV. Until 2015, ZIKV infection was thought to only cause asymptomatic or mild exanthematous febrile infections. However, after explosive ZIKV outbreaks in Polynesia and Latin American countries, it was confirmed that ZIKV could also lead to Guillain-Barré syndrome and congenital birth abnormalities. These abnormalities, which can include neurologic, ophthalmologic, audiologic, and skeletal findings, are now considered congenital Zika syndrome (CZS). Brain abnormalities in CZS include cerebral calcifications, malformations of cortical development, ventriculomegaly, lissencephaly, hypoplasia of the cerebellum and brainstem. The ocular findings, which are present in up to 70% of infants with CZS, include iris coloboma, lens subluxation, cataract, congenital glaucoma, and especially posterior segment findings. Loss of retinal pigment epithelium, the presence of a thin choroid, a perivascular choroidal inflammatory infiltrate, and atrophic changes within the optic nerve were seen in histologic analyses of eyes from deceased fetuses. To date, there is no ZIKV licensed vaccines or antiviral therapies are available for treatment. Preventive measures include individual protection from mosquito bites, control of mosquito populations and the use of barriers measures such as condoms during sexual intercourse or sexual abstinence for couples either at risk or after confirmed infection. A literature review based on studies that analyzed ocular findings in mothers and infants with CZS, with or without microcephaly, was conducted and a theoretical pathophysiologic explanation for ZIKV-ocular abnormalities was formulated.

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