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Carmel Mercado, Euna B Koo; Incidence of Cytomegalovirus-Related Ocular Disease in Pediatric Patients. Invest. Ophthalmol. Vis. Sci. 2018;59(9):170.
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© ARVO (1962-2015); The Authors (2016-present)
Cytomegalovirus (CMV) can cause devastating ocular disease in immunocompromised individuals. Appropriate screening is particularly critical in the pediatric population as patients may be unable to verbalize symptoms. Currently there are no formal guidelines as to how these patients should be screened and continuously monitored for eye disease while viremic. At the Lucile Packard Children’s Hospital, we conducted a 10 year retrospective clinical study to learn about the incidence of CMV-related ocular disease and characterize those who developed eye disease.
This study was a retrospective review of the medical history and serial ophthalmic exams of pediatric patients (N=291 (162 male, 129 female), mean age 90±4 months) seen between 2007 and 2017 at one institution who had both immunosuppressed status AND >135 copies/mL of CMV by polymerase chain reaction (PCR). The population incidence was analyzed based on immune status: immature immunity, innate immunodeficiency, or secondary immunodeficiency. Incidence was also analyzed based on stem cell transplant (SCT) history. The primary outcome was CMV ocular disease.
Of the 291 patients, there was 1 case of CMV retinitis and 1 case of retinal hemorrhage that resolved while on anti-virals in 2 children with congenital CMV infection (N=15). In those who had SCT (N=56, 2 with severe combined immunodeficiency (SCID), 37 with hematologic malignancy, 17 with other diagnoses), 35 had eye exams for pre-SCT or malignancy-related screening, of which 10 had subconjunctival hemorrhage and/or retinal hemorrhage secondary to their systemic disease with no associated retinitis. In the 220 without SCT (5 with SCID, 26 with hematologic malignancy, 150 with history of organ transplant, 39 with other diagnoses), 33 had eye exams, of which 10 had eye findings related to their systemic diagnoses. No CMV ocular disease was noted in the SCT and non-SCT groups.
CMV-related ocular disease was a rare occurrence in our patient population. However, not all patients who had positive CMV PCR underwent an eye exam. With no clear guidelines for when ophthalmology should be consulted, the occurrence of an eye exam following positive CMV PCR was inconsistent. Given the rare incidence of CMV-related eye disease, a multi-center study remains necessary to further characterize associated risk factors and subsequently develop screening guidelines.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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