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S. Putano, S. Lupo, D. Domanico, M.R. Cuomo, N. Catania, E.M. Vingolo; Congenital Cytomegalovirus(CMV) Infection: Retinal Damage . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5276.
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Purpose:to evaluate a cohort of infants born from CMV infected women in order to define the different clinical retinal picture. Methods: The study group was comprised of 16 infants and children with congenital CMV infection of an age between 1 month and 3 years. Those children, under treatment by Infectious Disease Institute, were sent for an eye examination to the Department of Hereditary Retina Disease of the 1st Ophthalmology Clinic of the University of Rome "La Sapienza". The diagnosis of CMV infection in pregnant women was based on the detection of specific IgM and IgG antibodies. The diagnosis in newborns was made with viral isolation using the shell–vial method that shows the nuclei of embrional fibroblast positives for the major immediate protein of HMCV. The viral isolation was carried out on urine samples in the first 2 or 3 weeks of life because after that time it is impossible to determine whether the infection was congenital or acquired. The eye examinations were conducted after a pupil dilatation with tropicamide 1% or 0.5%. Binocular indirect ophthalmoscopy was used to determine the integrity of the posterior pole and peripheral retina of both eyes. In our research we used an innovative classification; we had considered like grading: 0 = no lesions, 1 = retina depigmentation, 2= salt and pepper lesions, 3= widespread depigmentation, 4= focus lesions. Results: Most of the children had normal fundus 43.75%, 18.75% retinal depigmentation, 25% salt and pepper degeneration,12.5% widespread depigmentation. Seven children came back for a second eye examination and the most common findings were no lesion and salt and pepper degeneration with a percentage of 42.86% and 28.5. The clinical pictures of retinal depigmentation and widespread depigmentation were less frequent with a percentage of 14.3 for both of them. However, in those seven cases, retinal pictures did not change from the first and the second eye examination. Discussion: The most common finding in CMV infection is chorioretinis. CMV retina lesion has a predilection for the macula, as do Toxoplasma and Herpes. Some lesions are large and involve both retina and choroid; others are more superficial and destroy only retina tissue. According to international epidemiology, the most part of the study group was asymptomatic; in fact only one child has a significant retinal impairment and only one can be considered symptomatic for a serious hearing loss. We had propose a classification of retinal clinical picture in order to clarify and standardize data among different researches.
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