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Prevalence and Characteristics of Cytomegalovirus Ocular Disease in Children: A Multi-Center Study
Carmel L Mercado1,2, Colin P Froines3, Eric D Gaier4,5,6,7
1Department of Ophthalmology, University of Washington, Seattle, WA, USA.
Insights
Cytomegalovirus (CMV) ocular disease is rare in children, with most cases occurring in stem cell transplant recipients. Integrated screening guidelines are proposed for this uncommon condition.
Area of Science:
- Pediatric Ophthalmology
- Infectious Diseases
- Hematology/Oncology
Background:
- Cytomegalovirus (CMV) infection is common in children, but ocular involvement is less frequent.
- Identifying risk factors for CMV ocular disease is crucial for early diagnosis and management.
Purpose of the Study:
- To determine the prevalence of cytomegalovirus (CMV) ocular disease in pediatric patients.
- To identify associated risk factors for ocular involvement in children with CMV viremia.
Main Methods:
- A retrospective, multicenter, cross-sectional study was conducted.
- Seven hundred ninety-three children with CMV viremia (polymerase chain reaction >135 copies/mL) were analyzed.
- Ophthalmologic examinations were reviewed to identify CMV ocular disease.
Main Results:
- 37% of children with CMV viremia underwent an ophthalmologic examination.
- CMV ocular disease was identified in 4% of those examined (13 cases).
- Most cases (90%) occurred in patients post-stem cell transplantation, excluding congenital CMV.
Conclusions:
- CMV ocular disease is a rare complication in pediatric patients with CMV viremia.
- Patients status post-stem cell transplantation are at higher risk.
- Integrated screening guidelines are suggested for this rare condition.
Purpose:
The objective of this study was to identify the prevalence of CMV ocular disease in children and to identify associated risk factors for ocular involvement.
Design:
Retrospective multicenter, cross-sectional study.
Methods:
Setting: Hospitalized patients screened for CMV viremia by PCR between 2005 and 2018 at four pediatric referral centers. Participants: Seven-hundred and ninety-three children showed CMV viremia (>135 copies/mL by polymerase chain reaction; PCR). Main Outcomes and Measures: (1) Occurrence of ophthalmologic examination. (2) Presence of CMV ocular disease, defined as retinitis, vasculitis, hemorrhage, optic nerve atrophy, or anterior uveitis in the setting of CMV viremia without other identifiable causes.
Results:
A total of 296/793 (37%) underwent ophthalmologic examination following CMV viremia. A total of23/296 patients (8%) had ocular symptoms prompting evaluation while the rest had eye exams for baseline screening unrelated to CMV viremia. Of these, 13 cases (4% of those with an eye exam) with ocular disease were identified (three congenital CMV, five severe combined immunodeficiency disorder (SCID) status post-stem cell transplantation, three hematologic malignancy status post-stem cell transplantation for two of them, one Evans syndrome status post-stem cell transplantation, and one medulloblastoma status post-bone marrow transplantation). No patients with solid organ transplantation developed CMV ocular disease in our cohort.
Conclusion:
CMV ocular disease was a rare occurrence in this cohort without an identifiable pattern across sub-groups. Excluding the three congenital CMV cases, nine out of ten patients with CMV ocular disease were status post-stem cell transplantation. We provide integrated screening guidelines based on the best available evidence for this rare condition.
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