September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Cytomegalovirus retinitis in the pediatric stem cell transplant population: report of a recent cluster and the development of an ophthalmic screening protocol
Author Affiliations & Notes
  • Marissa Bucci
    Ophthalmologic, University of Colorado, Aurora, Colorado, United States
  • Ryan Phan
    School of Medicine, University of Colorado, Aurora, Colorado, United States
  • John Craddock
    Children's Hospital of Colorado, Aurora, Colorado, United States
  • Mark Abzug
    Children's Hospital of Colorado, Aurora, Colorado, United States
  • Donna Curtis
    Children's Hospital of Colorado, Aurora, Colorado, United States
  • Emily A McCourt
    Children's Hospital of Colorado, Aurora, Colorado, United States
    Ophthalmologic, University of Colorado, Aurora, Colorado, United States
  • Alan G Palestine
    Ophthalmologic, University of Colorado, Aurora, Colorado, United States
  • Footnotes
    Commercial Relationships   Marissa Bucci, None; Ryan Phan, None; John Craddock, None; Mark Abzug, None; Donna Curtis, None; Emily McCourt, None; Alan Palestine, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 4490. doi:
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      Marissa Bucci, Ryan Phan, John Craddock, Mark Abzug, Donna Curtis, Emily A McCourt, Alan G Palestine; Cytomegalovirus retinitis in the pediatric stem cell transplant population: report of a recent cluster and the development of an ophthalmic screening protocol
      . Invest. Ophthalmol. Vis. Sci. 2016;57(12):4490.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The incidence of cytomegalovirus (CMV) retinitis in the pediatric hematopoietic stem cell transplant (HSCT) population is unknown. We report a retrospective, observational clinical study of a cluster 5 patients in the last year with CMV retinitis and an ophthalmic screening protocol developed in response to this experience.

Methods : Pediatric HSCT patients at Children’s Hospital of Colorado (CHCO) with CMV viremia underwent dilated fundoscopic examination between September 2014-August 2015. Diagnosis of CMV retinitis was based on clinical exam with characteristic retinal whitening and hemorrhage. A panel of specialists in pediatric ophthalmology, uveitis, infectious disease and oncology was convened to develop an ophthalmic screening protocol for the CHCO HSCT population.

Results : Five cases of CMV retinitis were diagnosed at a median of 91 days (range 22-149 days) after onset of viremia. None of the patients reported visual complaints prior to or at the time of their diagnosis. One patient (age 5 years) did have severely decreased vision at time of diagnosis but did not report visual symptoms. Four of these patients underwent anterior chamber paracentesis; aqueous samples from three were positive for CMV by polymerase chain reaction. Patients were treated with systemic antivirals, intravitreal antiviral injections (1 patient) and infusion of CMV-specific cytotoxic T-lymphocyes (1 patient).
The result of the multi-disciplinary meeting was the development of a new ophthalmic screening protocol for CHCO HSCT patients : All patients undergo a baseline dilated exam with fundus photos prior to HSCT and dilated exam 3 months and 12 months post-HSCT. If CMV viremia is diagnosed, the patient has a new baseline exam within 2 weeks and dilated exams every 6-8 weeks until resolution of viremia and restoration of the immune system.

Conclusions : This cluster of CMV retinitis suggests that this entity may be underdiagnosed in pediatric HSCT patients. Considering the infrequency of visual complaints in this young population, regular dilated exams are necessary for diagnosis. We propose a screening protocol to diagnose retinitis in pediatric HSCT patients in the early, often asymptomatic stage.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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