Glaucoma Work-up in Congenital Zika Syndrome.

PURPOSE: To perform a glaucoma work-up in infants with congenital Zika syndrome (CZS).

PATIENT AND METHODS: This cross-sectional study included 188 eyes of 107 children (1.1 ± 0.3▒y [range, 0.3-1.8▒y]) with CZS. The confirmation of the syndrome was possible in 77/107 (72.0%) of the enrolled infants based on positive immunoglobulin M antibody capture enzyme-linked immunosorbent assay for Zika virus in the cerebrospinal fluid. All infants underwent a complete ophthalmic examination and bilateral fundus imaging was captured using a wide-angle digital fundus camera (RetCam™; Natus Medical Inc., Pleasanton, CA).

RESULTS: Five eyes (2.6%) presented two criteria for glaucoma diagnosis: one eye (0.5%) presented increased intraocular pressure and increased vertical cup-to-disc ratio (CDR); three eyes (1.6%) presented increased horizontal corneal diameter and increased vertical, and and one eye (0.5%) myopia related to increased axial length and increased vertical CDR. When excluding the CDR criterion, there was no case of glaucoma in this sample. A significant correlation was observed between high vertical CDR and small cephalic perimeter at birth (P=0.002) the and presence of clinical macular lesions (P=0.031).

CONCLUSION AND RELEVANCE: Although childhood glaucoma was not detected in this sample, increased vertical CDR is present in children with CZS, associated with microcephaly and clinical macular lesions at birth. This finding may lead to a misdiagnosis of glaucoma.