Long-term visual and neurodevelopmental outcomes in children with Congenital Zika Syndrome after undergoing strabismus surgery

ABSTRACT

Purpose: To assess long-term visual and neurodevelopmental outcomes in children with congenital Zika syndrome (CZS) after strabismus surgery. Methods: A consecutive sample of five children with CZS who underwent strabismus surgery was enrolled. All children underwent a standardized pre- and postoperative protocol including binocular best-corrected visual acuity (BCVA) using the Teller Acuity Cards II (TAC II), ocular alignment, functional vision using the functional vision developmental milestones test (FVDMT), and neurodevelopmental milestone evaluation using the Bayley Scales of Infant Development-Third Edition (BSID-III). Scores of the FVDMT outcomes considering the child’s developmental age based on the BSID-III score were compared with scores from postoperative assessment. Results: Five children with CZS (3 girls, 2 boys) were enrolled with a mean age at baseline (preoperative) of 35.0 ± 0.7 months (range, 34–36 months) and at final assessment of 64.4 ± 0.5 months (range, 64–65 months). Preoperative BCVA was 1.2 ± 0.5 logMAR and at final assessment 0.7 ± 0.1 logMAR. Successful strabismus surgery outcome was maintained in 4/5 (80.0%) of children at final assessment. The children’s BSID-III scores showed significant neurodevelopment delay at the initial assessment (corresponding developmental mean age was 4.7 months) and at their final assessment (corresponding developmental mean age was 5.1 months). There was improvement or stability in 34/46 items evaluated in the FVDMT (73.9%) when comparing baseline with 2-year follow-up. Conclusions: Strabismus surgery resulted in long-term ocular alignment in the majority of children with CZS. All the children showed improvement or stability in more than 70.0% of the functional vision items assessed. Visual and neurodevelopmental dysfunction may be related to complex condition and associated disorders seen in CZS including ocular, neurological, and skeletal abnormalities.

KEYWORDS:

• Cerebral visual impairment
• congenital Zika syndrome
• neurodevelopment
• strabismus
• surgery
• visual outcome

Acknowledgements

We thank the children and families/caregivers who took part in this study. We thank the contributions of the multidiscipline team of the Rehabilitation Center and the Department of Research of the Altino Ventura Foundation. We also thank Dr. Daena Leal for reviewing the visual acuity data and Dr. Linda Lawrence for reviewing this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributors

LOV is responsible for the study design, performed the ophthalmological assessments, did the literature review, drafted the report, and reviewed the final manuscript. RB conceived the study design, made the developmental assessments, did the literature review, led the data analyses, and drafted the report. CM made the development assessments. TF made the function visual milestones assessments and analyzed this data. CR led the data analyses. JMFS and CVV provided critical inputs to the report. All authors revised and approved the final version.

Additional information

Funding

Funding for the study was provided by grant [1R01HD093572-0] from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.