Maternal Zika Positivity May Lead to Choroiditis-Related Scarring in Newborns

Infants exposed to the Zika virus (ZIKV) during pregnancy could develop choroiditis-related scarring during fetal growth, according to a study published in JAMA Ophthalmology. However, the investigators point out that these findings are rare — appearing in approximately 0.9% of the exposed population.

In a cross-sectional multicentric study, researchers at French Guiana, Guadeloupe, and Martinique hospitals collected data on 1180 newborns between August 2016 to April 2019 assess the prevalence of fundus anomalies during the ZIKV epidemic. The mothers’ blood was drawn during pregnancy to confirm ZIKV by PCR test. Researchers collected patient demographic data for both the mothers and children and screened patients for comorbidities that could cause ocular anomalies. Researchers obtained widefield retinal imaging for 717 infants. 

A total of 330 infants (mean age, 68 days [22–440 days]; 51.5% girls; 48.5% boys) had ZIKV confirmed in the mothers. A majority of the mothers were in their second trimester (47.6%) at the time of infection. Fourteen children presented with anomalies in the fundus; however, 3 (0.9%) had anomalies compatible with congenital ZIKV infection. A single infant had a chorioretinal scar associated with iris and lens coloboma, 1 had a chorioretinal scar, and 1 had torpedo maculopathy. 

“We hypothesize that the neurotropic nature of ZIKV could lead to congenital damage to the temporal bulge at the origin of torpedo maculopathy. To our knowledge, ZIKV would be the first reported cause of torpedo maculopathy,” the researchers explain. “Regarding the chorioretinal scarring, we found this condition in 2 patients possibly associated with ZIKV infection.”

Extraocular fetopathies compatible with ZIKV occurred in 20 (6.1%) of the infants. The researchers determined the odds of developing lesions compatible with ZIVK were not significant (OR: 8.1 [0.7-93.4]; P =.09). The investigators described the lesions as “pigment mottling or chorioretinal scarring.”

Microcephaly was not associated with lesions compatible with ZIKV infections (OR, 9.1 [0.8 – 105.3; P =.08], except in  severe cases (OR, 81 [5.1-1297.8; P =.002). 

Researchers suggest that an association between ocular anomalies in newborns and ZIKV may occur. These lesions, that impact the choroid and retina, are rare but may be associated with fetal growth.

Researchers excluded positive ZIKV immunoglobulin M or G serology during pregnancy as the study population was recently exposed to a gangue epidemic.