Zika Retinitis : Ophthalmic implication of Zika Virus
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Zika virus is a flavivirus first isolated in Africa in 1947 in Rhesus monkey with fever in Zika Forest in Uganda, the virus transmitted to humans through mosquitoes: Classically in acute infection individuals present with fever, skin rash, itching, and conjunctival hyperemia (non-purulent conjunctivitis). General symptoms are very similar to those seen in dengue fever and chikungunya therefore the confirmed diagnosis relay on specific laboratory tests. In general, it is a benign disease, although few cases of neurological complications such as Guilian-Barre syndrome have been reported.

Ocular disease

Ocular disease secondary to Zika virus infection was first described in newborn from an infected mother during pregnancy. The patient presented with macular atrophy and microcephaly. Miranda et al. published other cases of congenital zika infection showing an expanded spectrum of congenital zika syndrome. Ocular changes include macular atrophic lesion, retinal pigment epithelium mottling, retinal hemorrhages, strabismus, and congenital cataract. First confirmed case of ocular zika infection in Brazil had acute non granulomatous anterior uveitis. Henry et al. described a case of a 60-year-old woman from Puerto Rico who presented with impaired visual acuities and fundus changes compatible with resolving unilateral acute maculopathy. The diagnosis was based on a positive PCR in blood although it was performed 7 weeks after prodromal illness. The diagnosis was considered presumed since other causes of infectious uveitis and lymphoma were excluded. Jimenes et al. reported a case of multifocal choroiditis secondary to acute zika virus infection.

Ocular symptoms started just after the onset of flulike illness, arthralgia, and skin rash. The diagnosis was confirmed by a positive PCR in peripheral blood within 14 days of systemic symptoms. Despite poor visual acuity in the left eye, the patient was not treated with any medication. The patient was followed for 2 years and showed progressive improvement in visual acuities. OCT changes and autofluorescence findings also improved without any specific treatment.

Treatment

There is no specific treatment available. Treatment is symptomatic and prevention is the only effective action to avoid the disease. In cases of anterior uveitis treatment with topical steroids have shown good response. In congenital zika syndrome rehabilitation includes surgery (strabismus, congenital cataract) and amblyopia treatment. In acute cases, close follow-up is important to monitor the resolution which is possible without any treatment. Zika virus infection can be acquired by congenital. Although rare, intraocular acquired Zika virus infection has a self-limiting course and a good outcome. The diagnosis is based on PCR from peripheral blood during the acute phase. Prevention is the only way to avoid zika virus infection.

Source: http://www.ijo.in/article.asp?issn=0301-4738;year=2020;volume=68;issue=9;spage=1775;epage=1786;aulast=Mahendradas
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