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Association of Anterior Uveitis With Acute Zika Virus Infection in Adults.
JAMA Ophthalmol. 2021 01 01; 139(1):95-102.JO

Abstract

Importance

Acute anterior uveitis has been reported to be associated with Zika virus (ZIKV) infection in case reports and retrospective studies based on systemic clinical signs of ZIKV and positive serologic tests.

Objective

To describe the ophthalmic findings associated with systemic ZIKV infection during the 2016 ZIKV outbreak in Guadeloupe in the French West Indies.

Design, Setting, and Participants

This cohort study assessed adult patients with red eye and virologic or serologic confirmation of acute ZIKV infection who were admitted to the Pointe-à-Pitre University Hospital from January 1, 2016, to January 1, 2017, for a systematic ophthalmologic examination. All patients with anterior uveitis also underwent a complete uveitis workup to rule out other causes of uveitis. Patients were excluded from the study if they had active uveitis and a history of uveitis or positive serology for other infectious diseases including dengue fever virus and chikungunya virus. Data were analyzed from January 1, 2016, to January 1, 2017.

Exposures

Patients with confirmed ZIKV infection underwent full ophthalmic examination at study inception and 3, 6, and 12 months.

Main Outcomes and Measures

Description of the presenting ocular characteristics, management, and outcome.

Results

Of 62 total patients with a red eye, 32 (51.6%) had no uveitis (mean [SD] age, 27.8 [3.7] years; 26 women [81.3%]) and 30 (48.4%) had anterior uveitis (mean [SD] age, 27.5 [3.8] years; 26 women [86.7%]), which was bilateral in all cases. Acute anterior uveitis was nongranulomatous and without synechiae, exhibiting mild anterior chamber reaction with small keratic precipitates. Ocular hypertension occurred in 25 patients (83.3%) with uveitis at presentation and persisted in 15 patients (50%) at 1 year despite antiglaucoma therapy and control of uveitis. Uveitis responded to topical steroids in all cases. Intraocular pressure was within normal limits for all patients without uveitis throughout the follow-up period.

Conclusions and Relevance

Anterior uveitis was present in almost half of patients with a red eye and acute systemic ZIKV infection; the uveitis was usually bilateral and often associated with increased intraocular pressure. These results suggest that ophthalmic evaluation should be performed in patients with red eye and acute ZIKV infection to potentially detect and manage hypertensive anterior uveitis.

Authors+Show Affiliations

Department of Ophthalmology, Centre Hospitalier de Perpignan, Perpignan, France. Department of Ophthalmology, Centre Hospitalier Universitaire, Guadeloupe, French West Indies.Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France.Faculty of Life Science and Medicine, King's College London, London, United Kingdom.Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil. Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil.Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France.Department of Ophthalmology, Centre Hospitalier National des Quinze Vingts, Paris, France.Virology Laboratory, National Reference Center of Arboviruses, Pastor Institute of Guyana, Cayenne, French Guiana.Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France.Department of Ophthalmology, Centre Hospitalier de Perpignan, Perpignan, France.Department of Ophthalmology, Centre Hospitalier Universitaire, Guadeloupe, French West Indies.Department of Ophthalmology, Centre Hospitalier Universitaire, Guadeloupe, French West Indies.

Pub Type(s)

Case Reports
Journal Article
Observational Study

Language

eng

PubMed ID

33237306

Citation

Troumani, Yacine, et al. "Association of Anterior Uveitis With Acute Zika Virus Infection in Adults." JAMA Ophthalmology, vol. 139, no. 1, 2021, pp. 95-102.
Troumani Y, Touhami S, Jackson TL, et al. Association of Anterior Uveitis With Acute Zika Virus Infection in Adults. JAMA Ophthalmol. 2021;139(1):95-102.
Troumani, Y., Touhami, S., Jackson, T. L., Ventura, C. V., Stanescu-Segall, D. M., Errera, M. H., Rousset, D., Bodaghi, B., Cartry, G., David, T., & Beral, L. (2021). Association of Anterior Uveitis With Acute Zika Virus Infection in Adults. JAMA Ophthalmology, 139(1), 95-102. https://doi.org/10.1001/jamaophthalmol.2020.5131
Troumani Y, et al. Association of Anterior Uveitis With Acute Zika Virus Infection in Adults. JAMA Ophthalmol. 2021 01 1;139(1):95-102. PubMed PMID: 33237306.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Anterior Uveitis With Acute Zika Virus Infection in Adults. AU - Troumani,Yacine, AU - Touhami,Sara, AU - Jackson,Timothy L, AU - Ventura,Camila V, AU - Stanescu-Segall,Dinu Michel, AU - Errera,Marie-Helene, AU - Rousset,Dominique, AU - Bodaghi,Bahram, AU - Cartry,Guilhem, AU - David,Thierry, AU - Beral,Laurence, PY - 2020/11/26/pubmed PY - 2021/4/27/medline PY - 2020/11/25/entrez SP - 95 EP - 102 JF - JAMA ophthalmology JO - JAMA Ophthalmol VL - 139 IS - 1 N2 - Importance: Acute anterior uveitis has been reported to be associated with Zika virus (ZIKV) infection in case reports and retrospective studies based on systemic clinical signs of ZIKV and positive serologic tests. Objective: To describe the ophthalmic findings associated with systemic ZIKV infection during the 2016 ZIKV outbreak in Guadeloupe in the French West Indies. Design, Setting, and Participants: This cohort study assessed adult patients with red eye and virologic or serologic confirmation of acute ZIKV infection who were admitted to the Pointe-à-Pitre University Hospital from January 1, 2016, to January 1, 2017, for a systematic ophthalmologic examination. All patients with anterior uveitis also underwent a complete uveitis workup to rule out other causes of uveitis. Patients were excluded from the study if they had active uveitis and a history of uveitis or positive serology for other infectious diseases including dengue fever virus and chikungunya virus. Data were analyzed from January 1, 2016, to January 1, 2017. Exposures: Patients with confirmed ZIKV infection underwent full ophthalmic examination at study inception and 3, 6, and 12 months. Main Outcomes and Measures: Description of the presenting ocular characteristics, management, and outcome. Results: Of 62 total patients with a red eye, 32 (51.6%) had no uveitis (mean [SD] age, 27.8 [3.7] years; 26 women [81.3%]) and 30 (48.4%) had anterior uveitis (mean [SD] age, 27.5 [3.8] years; 26 women [86.7%]), which was bilateral in all cases. Acute anterior uveitis was nongranulomatous and without synechiae, exhibiting mild anterior chamber reaction with small keratic precipitates. Ocular hypertension occurred in 25 patients (83.3%) with uveitis at presentation and persisted in 15 patients (50%) at 1 year despite antiglaucoma therapy and control of uveitis. Uveitis responded to topical steroids in all cases. Intraocular pressure was within normal limits for all patients without uveitis throughout the follow-up period. Conclusions and Relevance: Anterior uveitis was present in almost half of patients with a red eye and acute systemic ZIKV infection; the uveitis was usually bilateral and often associated with increased intraocular pressure. These results suggest that ophthalmic evaluation should be performed in patients with red eye and acute ZIKV infection to potentially detect and manage hypertensive anterior uveitis. SN - 2168-6173 UR - https://www.unboundmedicine.com/medline/citation/33237306/Association_of_Anterior_Uveitis_With_Acute_Zika_Virus_Infection_in_Adults_ L2 - https://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2020.5131 DB - PRIME DP - Unbound Medicine ER -