Mercado Carmel L, Froines Colin P, Gaier Eric D, Wang Qinyun, Indaram Maanasa, Wan Michael J, Shah Ankoor S, Koo Euna B
Department of Ophthalmology, University of Washington, Seattle, WA, USA.
Department of Ophthalmology, Seattle Children's Hospital, Seattle, WA, USA.
Clin Ophthalmol. 2022 Jul 8;16:2209-2217. doi: 10.2147/OPTH.S364741. eCollection 2022.
The objective of this study was to identify the prevalence of CMV ocular disease in children and to identify associated risk factors for ocular involvement.
Retrospective multicenter, cross-sectional study.
Setting: Hospitalized patients screened for CMV viremia by PCR between 2005 and 2018 at four pediatric referral centers. Participants: Seven-hundred and ninety-three children showed CMV viremia (>135 copies/mL by polymerase chain reaction; PCR). Main Outcomes and Measures: (1) Occurrence of ophthalmologic examination. (2) Presence of CMV ocular disease, defined as retinitis, vasculitis, hemorrhage, optic nerve atrophy, or anterior uveitis in the setting of CMV viremia without other identifiable causes.
A total of 296/793 (37%) underwent ophthalmologic examination following CMV viremia. A total of23/296 patients (8%) had ocular symptoms prompting evaluation while the rest had eye exams for baseline screening unrelated to CMV viremia. Of these, 13 cases (4% of those with an eye exam) with ocular disease were identified (three congenital CMV, five severe combined immunodeficiency disorder (SCID) status post-stem cell transplantation, three hematologic malignancy status post-stem cell transplantation for two of them, one Evans syndrome status post-stem cell transplantation, and one medulloblastoma status post-bone marrow transplantation). No patients with solid organ transplantation developed CMV ocular disease in our cohort.
CMV ocular disease was a rare occurrence in this cohort without an identifiable pattern across sub-groups. Excluding the three congenital CMV cases, nine out of ten patients with CMV ocular disease were status post-stem cell transplantation. We provide integrated screening guidelines based on the best available evidence for this rare condition.
本研究的目的是确定儿童巨细胞病毒（CMV）眼病的患病率，并确定眼部受累的相关危险因素。
回顾性多中心横断面研究。
研究背景：2005年至2018年期间，在四个儿科转诊中心通过聚合酶链反应（PCR）筛查CMV病毒血症的住院患者。参与者：793名儿童出现CMV病毒血症（聚合酶链反应>135拷贝/mL；PCR）。主要结局和指标：（1）眼科检查的发生率。（2）CMV眼病的存在，定义为在无其他可识别病因的CMV病毒血症情况下出现视网膜炎、血管炎、出血、视神经萎缩或前葡萄膜炎。
共有296/793（37%）的患者在CMV病毒血症后接受了眼科检查。共有23/296例患者（8%）因眼部症状而接受评估，其余患者进行眼科检查是为了与CMV病毒血症无关的基线筛查。其中，13例（眼科检查患者的4%）被确诊患有眼病（3例先天性CMV，5例严重联合免疫缺陷病（SCID）干细胞移植后，其中3例血液系统恶性肿瘤干细胞移植后，1例埃文斯综合征干细胞移植后，1例髓母细胞瘤骨髓移植后）。在我们的队列中，没有实体器官移植患者发生CMV眼病。
在该队列中，CMV眼病很少见，且各亚组之间没有可识别的模式。排除3例先天性CMV病例后，10例CMV眼病患者中有9例是干细胞移植后。我们基于现有最佳证据为这种罕见疾病提供了综合筛查指南。
