Ocular histopathologic features of congenital Zika syndrome

Maria P. Fernandez, Edgar Parra Saad, Martha Ospina Martinez, Sheryl Corchuelo, Marcela Mercado Reyes, Maria Jose Herrera, Miguel Parra Saavedra, Angelica Rico, Angela M. Fernandez, Richard K Lee, Camila V. Ventura, Audina Berrocal, Sander Dubovy

Research output: Contribution to journalArticle

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Abstract

IMPORTANCE: Congenital Zika syndrome (CZS) is known to be associated with severe malformations in newborns. Although microcephaly is the hallmark of this disease, the ocular findings are important given the severe visual impairment that has been observed in these patients. Regardless of the increased number of CZS cases reported, to date, no studies have described the ocular histopathologic findings of this entity. OBJECTIVES: To evaluate the presence of Zika virus (ZIKV) antigens and describe the associated ocular histopathologic features of 4 cases of CZS. DESIGN, SETTING, AND PARTICIPANTS: In this observational case series performed from June 19, 2015, through April 30, 2017, ocular tissue samples from 4 deceased fetuses with a diagnosis of CZS from the National Institute of Health in Colombia were sent to the Florida Lions Ocular Pathology Laboratory for evaluation. MAIN OUTCOMES AND MEASURES: The microscopic features of each specimen were described, and immunostaining was performed using a ZIKV NS2B protein antibody. RESULTS: Ocular tissue samples from the 4 deceased fetuses (2 female, 2 male) ranging from 21.5 to 29 weeks’ gestation with a diagnosis of CZS were studied. The 4 eyes manifested with pupillary membranes, immature anterior chamber angles, loss of pigment and thinning of the retinal pigment epithelium, choroidal thinning, undifferentiated nuclear layers of the retina, and a perivascular inflammatory infiltrate within the choroid. The optic nerve, present in 2 of the eyes, demonstrated atrophy. Expression of ZIKV antigen was present in the iris in cases 1, 3, and 4; the neural retina and choroid in case 1; and in the optic nerve in case 4. CONCLUSIONS AND RELEVANCE: Loss of retinal pigment epithelium, the presence of a thin choroid, a perivascular choroidal inflammatory infiltrate, and atrophic changes within the optic nerve were consistently present. These findings may be attributed to ZIKV infection and warrant further study.

Original languageEnglish (US)
Pages (from-to)1163-1169
Number of pages7
JournalJAMA Ophthalmology
Volume135
Issue number11
DOIs
StatePublished - Nov 1 2017

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Choroid
Optic Nerve
Retinal Pigment Epithelium
Retina
Fetus
Lions
Antigens
Microcephaly
Colombia
Vision Disorders
National Institutes of Health (U.S.)
Anterior Chamber
Iris
Atrophy
Newborn Infant
Pathology
Pregnancy
Membranes
Antibodies
Zika Virus

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Fernandez, M. P., Parra Saad, E., Ospina Martinez, M., Corchuelo, S., Mercado Reyes, M., Herrera, M. J., ... Dubovy, S. (2017). Ocular histopathologic features of congenital Zika syndrome. JAMA Ophthalmology, 135(11), 1163-1169. https://doi.org/10.1001/jamaophthalmol.2017.3595

Ocular histopathologic features of congenital Zika syndrome. / Fernandez, Maria P.; Parra Saad, Edgar; Ospina Martinez, Martha; Corchuelo, Sheryl; Mercado Reyes, Marcela; Herrera, Maria Jose; Parra Saavedra, Miguel; Rico, Angelica; Fernandez, Angela M.; Lee, Richard K; Ventura, Camila V.; Berrocal, Audina; Dubovy, Sander.

In: JAMA Ophthalmology, Vol. 135, No. 11, 01.11.2017, p. 1163-1169.

Research output: Contribution to journalArticle

Fernandez, MP, Parra Saad, E, Ospina Martinez, M, Corchuelo, S, Mercado Reyes, M, Herrera, MJ, Parra Saavedra, M, Rico, A, Fernandez, AM, Lee, RK, Ventura, CV, Berrocal, A & Dubovy, S 2017, 'Ocular histopathologic features of congenital Zika syndrome', JAMA Ophthalmology, vol. 135, no. 11, pp. 1163-1169. https://doi.org/10.1001/jamaophthalmol.2017.3595
Fernandez MP, Parra Saad E, Ospina Martinez M, Corchuelo S, Mercado Reyes M, Herrera MJ et al. Ocular histopathologic features of congenital Zika syndrome. JAMA Ophthalmology. 2017 Nov 1;135(11):1163-1169. https://doi.org/10.1001/jamaophthalmol.2017.3595
Fernandez, Maria P. ; Parra Saad, Edgar ; Ospina Martinez, Martha ; Corchuelo, Sheryl ; Mercado Reyes, Marcela ; Herrera, Maria Jose ; Parra Saavedra, Miguel ; Rico, Angelica ; Fernandez, Angela M. ; Lee, Richard K ; Ventura, Camila V. ; Berrocal, Audina ; Dubovy, Sander. / Ocular histopathologic features of congenital Zika syndrome. In: JAMA Ophthalmology. 2017 ; Vol. 135, No. 11. pp. 1163-1169.
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