Abstract
Purpose :
No consensus guidelines are established on the need for routine ophthalmic examination among infants and children with cytomegalovirus (CMV) infection. We performed a multi-center, retrospective observational study to investigate the rate of CMV retinitis (CMVR) among pediatric patients with CMV infection and associations between patient characteristics and CMVR risk.
Methods :
49 patients under the age of 18 who had an ICD-10 diagnosis code for CMV infection and who underwent comprehensive ophthalmic examination at three different academic centers between 2010 and 2020 were included.
Results :
2 of 49 pediatric patients (4.1%) had CMVR on exam. No neonates (less than 1 month of age) were diagnosed with CMVR, including all neonates who were congenitally infected. Average age was 4.2 years (standard deviation (SD) 5.4), with 23 males (47%). 15 children were identified as Hispanic (31%), 9 Black (18%), 8 White (16%), 0 Asian, and 18 (37%) did not have a recorded race or ethnicity. The documented reason for immunocompromise or exposure to CMV infection was transplant-related immunosuppression in 18 (37%) patients, congenital infection in 14 (29%) patients, premature birth in 6 (12%) patients, and malignancy in 6 (12%) patients. 4 patients had no documented reason for immunocompromise. Of note, no patients had HIV/AIDS infection. Among the 2 CMVR patients, one was a post-transplant 7-year-old; the second was an 8-month-old child with known history of congenital CMV infection, who was noted to have central corneal opacity and esotropia in addition to CMVR.
Conclusions :
Pediatric patients are immunosuppressed and exposed to CMV differently than adult patients; the majority in this cohort (66%) were either exposed congenitally or immunosuppressed after solid-organ or bone marrow transplant. Children are at risk for CMVR and often uniquely unable to communicate the presence of ocular symptoms. Our findings suggest children who are post-transplant and have CMV infection should be screened for CMVR, but CMVR in neonates is rare. Larger case series establishing incidence and prevalence of CMVR in neonates are needed.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.