PHTHALMOLOGIC SCREENING FOR ZIKA VIRUS...
Transcript of PHTHALMOLOGIC SCREENING FOR ZIKA VIRUS...
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OPHTHALMOLOGIC SCREENING FORZIKA VIRUS SYNDROME
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ZIKA VIRUS
• CDC: GLOBAL ALERT• HIGH EVIDENCES OF MICROCEPHALY• WHO:• INTERNATIONAL PUBLIC HEALTH EMERGENCY
MICROCEPHALY - Brazil:
2010-2014 = 781 CASES
2015-2016 = 5909 CASES
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MICROCEPHALY
2010-2014 = 781 CASES
2015-2016 = 5909 CASES
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OPHTHALMIC FINDINGS
• First report• Atrophic Retina lesion
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WOC MEXICO 2016
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Zika Embryopathy: Evaluation and Management Recommendations for Ophthalmologists
Sociedad de Oftalmologia Pediatrica Latinoamericana(SOPLA)
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RECOMMENDATIONS
In newborns or babies with evidence of or suspicion for CZS or microcephaly, the ophthalmologic examination should include:Indirect ophthalmoscopy with mydriasis= EYE FUNDUS EVALUATION
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RECOMMENDATIONS
Protection for all medical personal should be instituted for the ophthalmological examination to minimize the risk of tear-born contamination or spread.
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RECOMMENDATIONS
First ophthalmological examination has to be performed within 30 days of birth.Red Reflex Test does NOT work for diagnosis in cases of CZS: 72 patients with CZS: normal RRT
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OCULAR FEATURES
• Important clinical criteria for CZS diagnosis• When laboratory tests are not available• Major sign of CZS - 30%
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OCULAR FINDINGS IN CZS: 30%
1. Chorioretinal atrophy (COLOBOMATOUS -LIKE): circular shape lesions including the macula: 65%2. Focal pigment mottling of the retina ephitelium: 65%3. Optic nerve abnormalities: 50%
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MACULAR ATROPHY
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OPTIC NERVEHYPOPLASIA, ATROPHY, PALLOR, DOBLE-RING SIGN
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RECOMMENDATIONS
Those newborns and babies with lesions in any part of the retina should be evaluated every 3 months for one year and every six months thereafter.
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RECOMMENDATIONS
Babies with macular atrophy or optic nerve abnormalities should be referred for low vision evaluation and visual rehabilitation.
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RECOMMENDATIONS
Those newborns and babies WITHOUT ocular lesions should be evaluated every 6 months.Cerebral visual impairment may occur without ophthalmologic lesions.= visual acuity Tests
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YOU TUBE:ZIKA OCULAR FINDINGS
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RECOMMENDATIONSEye exam: Refraction = evaluation before 12 months of age.If refractive error occurs, glasses should be prescribed.
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RECOMMENDATIONSThe presence of strabismus (crossed eyes) and nystagmus (involuntary eye movements) has to be observed in all pediatric and ophthalmic visits: early onset strabismus.STRABISMUS: 14% CZS x 3-5% NL
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OTRAS ALTERACIONES OCULARES RELACIONADAS A INFECCION CONGENITA POR ZIKA VIRUS
1. CATARATA CONGENITA = 2 CASOS2. MICROFTALMIA = 1 CASO3. ESTRABISMO4. BAJA VISUAL DE ORIGEN CEREBRAL5. CONGENITAL GLAUCOMA
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SUMMARY
• First Eye examination within 30 days of life• Presence of ocular lesions: repeat eye exam
every 3 months• No ocular involvement: every 6 months• Evaluation: Refraction, strabismus ,
nystagmus, low vision• Early Visual Intervention and Visual and motor
Rehabilitation
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REFERENCES
• Zika Virus in Brazil and Macular atrophy in a child with microcephaly. Ventura,C, Mia, M, Bravo-Filho, V, Gois, A, Belfort Jr, R. Lancet, January, 2016.
• Ocular findings in Infants with Microcephly associated with presumable Zika Virus Congenital Infection, in Salvador , Brazil. Freitas,BP, Dias, JRO, Prazeres, J, Sacramento, GA, Ko, AI, Maia, M, Belfort Jr, R. JAMA, February, 2016
• Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection. Ventura,CV , Maia,M , Ventura, BV, Van Der Linden,V , Araújo. EB , Ramos, RC, Rocha, MAW, Carvalho, MDCG , Belfort Jr., R , Ventura, LO Arq. Bras. Oftalmol. 79:1 jan./fev. 2016.http://dx.doi.org/10.5935/0004-2749.20160002
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GRACIASTHANK YOU
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CONCLUSIONES
ALTERACIONES OCULARES RELACIONADAS A INFECCION CONGENITA POR ZIKA VIRUS
1. ATROFIA CORIORRETINIANA2. ALTERACIONES PIGMENTARES EN FORMA DE MOTEADO 3. HIPOPLASIA O AUMENTO DE ESCAVACION DEL NERVIO OPTICO
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Recomendaciones de SOPLA para manejo oftalmológico depacientes pediátricos con sospecha de contaminación por virus deZika y pacientes recién nascidos con microcefalia
•En bebés con diagnóstico presuntivo o confirmado de microcefalia se requiere al menosun examen oftalmológico bajo MIDRIASIS con oftalmoscopía INDIRECTA con el objetivode detectar lesiones oculares, maculares o periféricas similares a retinocoroiditis cicatrizal(similar a toxoplasma-histoplasmosis no tan pigmentadas o colobomatous -like).•Se deben revisar a todos los bebés cuya madre tenga sospecha de contaminación porZika (rash cutáneo, fiebre, artralgia).•Si hubieran lesiones en la mácula el bebé tendrá baja visión y deberá ser referido arehabilitación visual
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•Si las lesiones fueran periféricas sin daño macular se recomiendan examen periódicosde seguimiento (cada 3 meses el primer año y después del 1er año cada 6 meses).•Los bebés con lesiones por virus del Zika se revisan cada 3 meses por un año. Los bebéssin lesiones se revisan cada 6 meses por un ano.•Debido a que no se conoce el grado de contaminación por lágrima se requiereprotección del personal de salud y esterilización del equipo para realizar la revisión.•Hacer el relato de los casos con hallazgos oculares para SOPLA para controlepidemiológico y para la Secretaria de Salud Ocular de su Ciudad.•Difundir las recomendaciones a las sociedades de Pediatría, Ginecología, Neurología.
Recomendaciones para manejo oftalmológico de pacientes pediátricos consospecha de contaminación por virus de Zika y pacientes recién nascidos conmicrocefalia