Andrea A Zin1, Irena Tsui2, Julia D Rossetto3, Stephanie L Gaw4, Luiza M Neves5, Olivia A Zin6, Lorena Haefeli3, Joel Carlos Barros Silveira Filho7, Kristina Adachi2, Marcos Vinicius da Silva Pone3, Sheila Moura Pone3, Natalia Molleri3, Jose Paulo Pereira3, Rubens Belfort8, Vaithilingaraja Arumugaswami2, Zilton Vasconcelos3, Patricia Brasil9, Karin Nielsen-Saines2, Maria Elisabeth Lopes Moreira3. 1. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira- Fundação Oswaldo Cruz, Rio de Janeiro. Electronic address: andreazin@iff.fiocruz.br. 2. University of California Los Angeles, Los Angeles, California. 3. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira- Fundação Oswaldo Cruz, Rio de Janeiro. 4. Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California. 5. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira- Fundação Oswaldo Cruz, Rio de Janeiro; Hospital Federal dos Servidores do Estado, Rio de Janeiro. 6. Hospital Federal dos Servidores do Estado, Rio de Janeiro. 7. Universidade Unigranrio, Rio de Janeiro. 8. Universidade Federal de São Paulo, São Paulo. 9. Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz, Rio de Janeiro.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
PURPOSE: 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. METHODS: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. RESULTS: 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). CONCLUSIONS: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.
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