Baumal C R, Levin A V, Read S E
Department of Ophthalmology, University of Toronto, Ontario, Canada.
Am J Ophthalmol. 1999 May;127(5):550-8. doi: 10.1016/s0002-9394(99)00031-8.
To describe the ocular and systemic features of children with cytomegalovirus retinitis and their disease outcomes.
Review of all cases of cytomegalovirus retinitis diagnosed or treated at a tertiary care pediatric hospital during a 10-year period.
Nine immunocompromised children younger than 16 years were diagnosed as having cytomegalovirus retinitis. The underlying causes of immunocompromise were severe combined immunodeficiency syndrome (n = 2), severe combined immunodeficiency syndrome after bone marrow transplantation (n = 1), acquired immunodeficiency syndrome (AIDS) (n = 2), AIDS and previous bone marrow transplantation for leukemia (n = 1), immunosuppressive therapy after renal transplantation (n = 1), chemotherapy for leukemia (n = 1), and congenital cytomegalovirus infection (n = 1). Five children (56%) had symptomatic extraocular cytomegalovirus infection. Only two children reported visual symptoms with cytomegalovirus retinitis at initial examination. Cytomegalovirus retinitis was bilateral in eight children (89%) and involved the posterior pole in at least one eye of all nine children. Four children (44%) died within 10 months of being diagnosed with cytomegalovirus retinitis. The remaining five children were alive, with follow-up ranging from 14 to 70 months. Successful bone marrow transplantation in one child and discontinuation of immunosuppressive medications in two children improved systemic immune function and permitted discontinuation of anticytomegaloviral therapy.
Pediatric cytomegalovirus retinitis is often asymptomatic and bilateral and involves the posterior pole at initial examination. Recovery of systemic immune function may occur in some children. Evaluation of children at risk and prompt treatment of cytomegalo. virus retinitis are important to prevent long-term visual morbidity.
描述患有巨细胞病毒性视网膜炎儿童的眼部和全身特征及其疾病转归。
回顾一家三级儿科医院在10年期间诊断或治疗的所有巨细胞病毒性视网膜炎病例。
9名16岁以下免疫功能低下的儿童被诊断患有巨细胞病毒性视网膜炎。免疫功能低下的潜在原因包括严重联合免疫缺陷综合征（n = 2）、骨髓移植后严重联合免疫缺陷综合征（n = 1）、获得性免疫缺陷综合征（艾滋病）（n = 2）、艾滋病并曾因白血病接受骨髓移植（n = 1）、肾移植后免疫抑制治疗（n = 1）、白血病化疗（n = 1）以及先天性巨细胞病毒感染（n = 1）。5名儿童（56%）有症状性眼外巨细胞病毒感染。初诊时仅有2名儿童报告有巨细胞病毒性视网膜炎的视觉症状。8名儿童（89%）的巨细胞病毒性视网膜炎为双侧性，所有9名儿童中至少有一只眼累及后极部。4名儿童（44%）在被诊断患有巨细胞病毒性视网膜炎后的10个月内死亡。其余5名儿童存活，随访时间为14至70个月。1名儿童成功进行了骨髓移植，2名儿童停用了免疫抑制药物，改善了全身免疫功能，并得以停用抗巨细胞病毒治疗。
儿童巨细胞病毒性视网膜炎通常无症状且为双侧性，初诊时累及后极部。部分儿童可能出现全身免疫功能恢复。对高危儿童进行评估并及时治疗巨细胞病毒性视网膜炎对于预防长期视觉损害很重要。
