Zika and the Eyes. William May, M.D. Associate Professor Co-director, Johns Hopkins Zika Center

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1 Zika and the Eyes William May, M.D. Associate Professor Co-director, Johns Hopkins Zika Center

2 Disclosure No conflicts

3 JOHNS HOPKINS ZIKA CENTER February

4 Since > 60 countries 3/15/2017

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6 ZIKA VIRUS TRANSMISSION Mosquitos - Aedes aegypti / Ae albopictus Congenital Sexual contact Person-to-person (Tears? Sweat?)1 Blood transfusion Laboratory exposure (1 US) 1Swaminathan et al. Fatal Zika virus infection with secondary nonsexual transmission N Engl J Med. Doi: /NEJMc

7 OPHTHALMOLOGIST & ZIKA - CZS 30-55% Eye disease Ventura CV, Maia M, Ventura BV, et al. Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection. Arq Bras Oftalmol. 2016;79(1):1-3.

8 OCULAR FINDINGS CZS % Ventura CV, Maia M, Ventura BV, et al. Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection. Arq Bras Oftalmol. 2016;79(1):1-3. de Paula Freitas B, de Oliveira Dias JR, Prazeres J, et al. Ocular findings in infants with microcephaly associated with presumed Zika virus congenital infection in Salvador, Brazil. JAMA Ophthalmol. 2016; 134(5):

9 OCULAR FINDINGS CZS Posterior segment Retina, optic nerve, retinal vessels Iris coloboma, lens subluxation, cataract, glaucoma, intraocular calcifications, microphthalmia, strabismus.. No inflammation Miranda et al. Expanded spectrum of congenital ocular findings in microcephaly with presumed Zika infection. Ophthalmology de Paula Freitas et al. Glaucoma and congenital Zika syndrome. JAMA Ophthalmol. 2016

10 OCT chorioretinal scars 8 babies 100% Discontinuation of the ellipsoid zone and hyper-reflectivity underlying the RPE; 89% Retinal thinning 78% Choroidal thinning 44% Colobomatous-like excavation

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13 Brain CT findings in children with microcephaly + prenatal Zika virus infection Cortical Blindness? Fatima Vasco Aragao M et al, BMJ, 2016

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17 APPROACH to Newborns - Comprehensive - Multispecialty team - Cortical visual impairment - Altino Ventura Foundation (FAV), Recife, BR - Reading glasses - Visual stimulation *Globo.com

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19 Approach CZS Eyes in US Mother ZIKV+ Exam of mother, father and child Newborn exam before discharge or 1m Reevaluation of newborn at 3m Even without microcephaly

20 ADULTS Conjunctivitis Hypertensive iridocyclitis Unilateral acute maculopathy Furtado et al. Uveitis associated with Zika virus infection. N Eng J Med Parke et al. Serologically confirmed Zika-related unilateral acute maculopathy in an adult. Ophthalmology. 2016

21 ADULTS Bilateral posterior uveitis Kodati et al. Bilateral posterior uveitis associated with Zika virus infection. The Lancet Guillain-Barré syndrome - Papilledema Optic Neuritis

22 Approach to Adults Acute phase Topical steroids, cycloplegic and hypotensive drops Warning of possible systemic disease in 2 weeks Prophylactic measures

23 Ongoing.. 21 babies Zikv + 9 retinal findings + 2 were not done

24 Can glasses prescriptions and visual stimulation promote visual development in children with CZS?

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26 Total Case Counts US (States) 2016/ June 1st/16 Sep 7th/16 Feb 1st/17

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28 Zikv Pregnant Women US (States) June 9th/16 Jan 24th/17

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30 Zikv Maryland June 1st/16 Feb 1st/17

31 THANK YOU!! JOHNS HOPKINS ZIKA CENTER