Department of Medical and Surgical Sciences, Neonatology Unit,St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences, Neonatology Unit,St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
J Clin Virol. 2017 Dec;97:59-63. doi: 10.1016/j.jcv.2017.11.001. Epub 2017 Nov 7.
Congenital cytomegalovirus (cCMV) infection is responsible of a high burden of neurosensory impairment in children.
To report incidence and consequences of ophthalmological abnormalities in infants with cCMV infection and better define their long-term ophthalmological management.
Infants with cCMV infection were enrolled in a 6-year follow-up. Infants were classified as symptomatic or asymptomatic based on complete clinical, laboratory and instrumental evaluations. All infants underwent funduscopic evaluation in neonatal period, and yearly complete ophthalmological evaluation, including funduscopic, motility and visual acuity assessments.
Forty-eight infants were enrolled, 18/48 (37.5%) symptomatic and 30/48 (62.5%) asymptomatic. Mean duration of follow-up was 34.9±22.2 vs. 34.8±20.1months (P=0.98). Funduscopic abnormalities were identified in neonatal period in 7/18 (39%) symptomatic infants and in none of the infants without other clinical and instrumental abnormalities at birth (P<0.001); chorioretinal scars were the most common finding (5/18 cases, 28%). Strabismus was detected in 1/18 (5.5%) symptomatic infants during the first years of life. Visual impairment at last follow-up evaluation was suspected or detected in 4/18 (22%) symptomatic infants and in none of the asymptomatic infants at birth (P=0.01). Ophthalmological abnormalities were associated with other signs of central nervous system (CNS) involvement (P<0.001). No correlation was found with the type of maternal infection.
Ophthalmological abnormalities were common in symptomatic infants though often not associated with long-term visual impairment, and correlated with the presence of CNS involvement. Neonatal and periodical ophthalmological evaluations throughout childhood seem prudential for symptomatic babies. No ophthalmological abnormalities were detected in asymptomatic infants, who might therefore undergo more deferred evaluations.
先天性巨细胞病毒（cCMV）感染是导致儿童神经感觉损伤的主要原因。
报告 cCMV 感染婴儿的眼部异常发生率和后果，并更好地定义其长期眼科管理。
对患有 cCMV 感染的婴儿进行了为期 6 年的随访。根据完整的临床、实验室和仪器评估，将婴儿分为有症状或无症状。所有婴儿均在新生儿期进行眼底检查，并每年进行全面的眼科评估，包括眼底检查、运动和视力评估。
共纳入 48 例婴儿，18/48（37.5%）为有症状，30/48（62.5%）为无症状。平均随访时间为 34.9±22.2 个月与 34.8±20.1 个月（P=0.98）。在 18 例有症状婴儿中有 7 例（39%）在新生儿期发现眼底异常，而在无其他出生时临床和仪器异常的婴儿中无一例（P<0.001）；脉络膜视网膜瘢痕是最常见的发现（5/18 例，28%）。在 18 例有症状婴儿中有 1 例（5.5%）在生命的最初几年出现斜视。在最后一次随访评估时，怀疑或发现 4 例（22%）有症状婴儿存在视力障碍，而出生时无症状婴儿无一例（P=0.01）。眼部异常与中枢神经系统（CNS）受累的其他表现相关（P<0.001）。与母亲感染的类型无关。
尽管眼部异常在有症状婴儿中很常见，但通常与长期视力损害无关，并且与 CNS 受累相关。在整个儿童期进行新生儿和定期眼科评估对有症状的婴儿似乎是谨慎的。无症状婴儿未发现眼部异常，因此可能需要进行更多的延迟评估。
