Al-Battashy Aisha, Al-Farsi Nouf
Department of Ophthalmology, Oman Medical Specialty Board, Muscat 132, Oman.
Department of Ophthalmology, Sultan Qaboos University, Muscat 123, Oman.
World J Stem Cells. 2025 Jul 26;17(7):107153. doi: 10.4252/wjsc.v17.i7.107153.
Cytomegalovirus (CMV) retinitis is a significant yet infrequent complication in pediatric hematopoietic stem cell transplant recipients, occurring in approximately 4% of cases. Its presentation typically coincides with immune reconstitution, between 6 weeks to 6 months post-transplant, emphasizing the need for timely detection. Symptoms often develop insidiously, underscoring the role of fundus examinations during episodes of CMV viremia. However, the low incidence challenges the necessity of routine screenings, as they may strain clinical resources without clear benefits to patient outcomes. Management includes systemic and intravitreal antivirals, such as ganciclovir and foscarnet, and adoptive T-cell therapy for refractory cases. Tailored follow-up strategies are crucial, with considerations for lesion activity and CMV viremia status to determine the duration of therapy. Baseline and post-transplant screenings remain a topic of debate, with evolving guidelines needed to balance patient safety and clinical feasibility. Future research is needed to address optimal screening intervals and investigate the role of pre-existing CMV serostatus in transplant eligibility and outcomes.
巨细胞病毒（CMV）视网膜炎是小儿造血干细胞移植受者中一种严重但不常见的并发症，发生率约为4%。其症状通常在移植后6周-6个月的免疫重建期出现，这凸显了及时检测的必要性。症状往往隐匿出现，这突出了在CMV病毒血症发作期间进行眼底检查的作用。然而，低发病率对常规筛查的必要性提出了挑战，因为这可能会消耗临床资源，而对患者预后并无明显益处。治疗方法包括全身和玻璃体内使用抗病毒药物，如更昔洛韦和膦甲酸钠，对于难治性病例采用过继性T细胞疗法。定制的随访策略至关重要，要考虑病变活动情况和CMV病毒血症状态来确定治疗持续时间。基线和移植后筛查仍是一个有争议的话题，需要不断完善指南以平衡患者安全和临床可行性。未来需要开展研究以确定最佳筛查间隔，并调查移植前CMV血清学状态在移植资格和预后中的作用。
