Schreiber Tamar, Tan Naomi, Bellchambers Alice, Rufai Sohaib R, Adorkor Nutifafa Thywill, Ahmed Umar, Petrushkin Harry, Solebo Ameenat Lola
Population, Policy and Practice Department of Research and Teaching, UCL GOS Institute of Child Health, London, UK.
University College London Medical School, London, UK.
EClinicalMedicine. 2025 Sep 2;88:103443. doi: 10.1016/j.eclinm.2025.103443. eCollection 2025 Oct.
Cytomegalovirus (CMV), the most common congenitally acquired infection, can result in visual disability in affected children. We aimed to estimate the burden of eye and vision disorders amongst children with symptomatic and asymptomatic congenital cytomegalovirus infection (cCMV), to inform the development of guidance for the provision of care.
In this systematic review and meta-analysis, we searched PubMed, Embase, and CINAHL databases up to 6th Feb 2025 for studies reporting ocular disorders or visual impairment (VI) outcomes following cCMV diagnosis. We included longitudinal or cross-sectional studies which reported the frequency of visual or ophthalmic outcomes following an initial diagnosis of symptomatic or asymptomatic cCMV. Summary data, and individual patient level data where available, on the proportions of children noted to have visual impairment or ophthalmic disorders and the manifestation of these disorders, were extracted from published reports. Pooled prevalence of eye and vision outcomes were estimated through random effects models computed using Restricted Maximum Likelihood (REML) estimation. We included studies at lower risk of bias (assessed using the Joanna Briggs Institute tool) in meta-analyses of prevalence (random-effect models) and undertook subgroup analyses. The review protocol was registered with PROSPERO, CRD42021284678.
We identified 4488 articles of which 28 were eligible for inclusion. Of these, 15 studies (total 858 children with symptomatic, 1176 with asymptomatic cCMV) were eligible for meta-analyses. Median follow up time from diagnosis of cCMV ranged from 6 to 156 months. Estimated pooled prevalence in symptomatic cCMV of visual impairment (VI) and ocular disorders 9% (95% CI, 5-14%, = 51.09%) and 14% (95% confidence interval, CI, 5-31%, = 93.2%) respectively. Cerebral visual impairment (i.e. VI due to neurological insult rather than ocular disease) was the most commonly reported visual disability, with an estimated pooled prevalence of 10% (95% CI, 6-15%, = 24.9). Prevalence of ocular disorders (most commonly chorioretinitis, and optic nerve and anterior segment anomalies) was higher in studies with greater proportions of pre-term birth, hearing impairment, and those undertaken prior to 2017. Estimated pooled prevalence of VI and ocular disorders was 1% and <1% (95% CI, 0-2%, = 0%) respectively in asymptomatic cCMV.
Visual disability in cCMV is a strong marker of the broader neurological insult. Ocular disorders are prevalent in symptomatic disease, with consequent need for ongoing ophthalmic care. The low prevalence of sight-impactful disorders in asymptomatic disease suggests little benefit for ongoing ophthalmic surveillance, particularly in health settings with established programmes for whole population childhood eye and vision screening. This review is limited by the absence of information on the timing of diagnosis of the eye and vision disorders, data which would support the development of timeline pathways for ophthalmic surveillance.
Wellcome Trust, National Institute for Health and Care Research (NIHR).
巨细胞病毒（CMV）是最常见的先天性感染病原体，可导致受感染儿童出现视力残疾。我们旨在评估有症状和无症状先天性巨细胞病毒感染（cCMV）儿童的眼部和视力障碍负担，为制定护理指南提供依据。
在这项系统评价和荟萃分析中，我们检索了截至2025年2月6日的PubMed、Embase和CINAHL数据库，以查找报告cCMV诊断后眼部疾病或视力损害（VI）结果的研究。我们纳入了纵向或横断面研究，这些研究报告了有症状或无症状cCMV初始诊断后视力或眼科结果的频率。从已发表的报告中提取了关于有视力损害或眼科疾病儿童比例及其这些疾病表现的汇总数据以及个体患者水平数据（如可用）。通过使用限制最大似然法（REML）估计计算的随机效应模型估计眼部和视力结果的合并患病率。在患病率的荟萃分析（随机效应模型）中，我们纳入了偏倚风险较低的研究（使用乔安娜·布里格斯研究所工具评估）并进行了亚组分析。该综述方案已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42021284678。
我们识别出4488篇文章，其中28篇符合纳入标准。其中，15项研究（共858例有症状cCMV儿童，1176例无症状cCMV儿童）符合荟萃分析标准。从cCMV诊断后的中位随访时间为6至156个月。有症状cCMV中视力损害（VI）和眼部疾病的估计合并患病率分别为9%（95%CI，5-14%，I² = 51.09%）和14%（95%置信区间，CI，5-31%，I² = 93.2%）。大脑性视力损害（即由于神经损伤而非眼部疾病导致的VI）是最常报告的视力残疾，估计合并患病率为10%（95%CI，6-15%，I² = 24.9）。在早产、听力障碍比例较高以及2017年之前开展的研究中，眼部疾病（最常见的是脉络膜视网膜炎、视神经和眼前节异常）的患病率更高。无症状cCMV中VI和眼部疾病的估计合并患病率分别为1%和<1%（95%CI，0-2%，I² = 0%）。
cCMV中的视力残疾是更广泛神经损伤的有力标志。眼部疾病在有症状疾病中很常见，因此需要持续的眼科护理。无症状疾病中对视力有影响的疾病患病率较低，这表明持续的眼科监测益处不大，特别是在已建立全人群儿童眼部和视力筛查计划的卫生机构中。本综述的局限性在于缺乏关于眼部和视力障碍诊断时间的信息，这些数据将有助于制定眼科监测的时间线路径。
惠康信托基金会、国家卫生与保健研究所（NIHR）。
