A Case of Lens Subluxation Associated with Congenital Cytomegalovirus Infection

Abstract

 

Purpose

 

To report a case of lens subluxation with congenital cytomegalovirus (CMV) infection. To the best of our knowledge, this is the first report about lens subluxation associated with congenital CMV infection.

 

Methods

 

A 2-year-old girl was diagnosed with CMV intrauterine infection resulting from a maternal primary CMV infection. She was treated before and after birth. During pregnancy, an intrauterine growth restriction was noted and the maternal CMV-specific immunoglobulin M (IgM) value was high. The amniotic fluid was positive for CMV DNA. CMV hyperimmunoglobulin was injected into the fetal abdominal cavity during pregnancy. The baby was born at 39 weeks gestation. She was positive for CMV-specific IgM and CMV DNA. She had bilateral dilation of the cerebral ventricles and sensorineural hearing impairment. Intravenous ganciclovir and CMV hyperimmunoglobulin therapy were administered.

 

Results

 

Slit-lamp biomicroscopy showed a subluxated lens in the left eye. Dehiscence of the zonules of Zinn and iris atrophy accompanied by pupillary deviation were seen nasally; gonioscopy showed anterior peripheral synechiae. No cataract was present; the cornea was normal. Ophthalmoscopy and fundus fluorescein angiography (FA) showed retinal vascular occlusions and elliptical chorioretinal atrophy adjacent to the macula in her right eye, white-yellowish lesions extended in the nasal peripheral retina to the ora serrata, which appeared as a window defect on FA in the left eye. Her visual acuity was 20/130 bilaterally according to the Teller acuity card.

 

Conclusions

 

Treatment was administered in the fetal abdominal cavity, which was the thirteenth such case in the world. In her left eye, dehiscence of ciliary zonules, iris atrophy, dyscoria, and retinal atrophic lesion were adjacent each other. The focus of inflammation in her left eye was thought to be in the ciliary body, iris, and peripheral chorioretinal; the lens subluxation might have been induced by strong cyclitis during development.

 

 

Left eye lens subluxation

 

 

Right eye macular degeneration FA

 

Keywords: 492 cytomegalovirus • 702 retinitis • 421 anterior segment