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Ophthalmologic findings in children with congenital cytomegalovirus infection,☆☆

https://doi.org/10.1067/mpa.2000.103870Get rights and content

Abstract

Background: Cytomegalovirus (CMV) infection is the most common congenital viral infection in the United States, affecting 0.5% to 2% of live births. Approximately 90% of infected infants are asymptomatic at birth. We undertook this study to determine the incidence and etiology of visual impairment and other ophthalmologic abnormalities in children with congenital CMV infection. Methods: We prospectively evaluated 42 symptomatic and 83 asymptomatic children with congenital CMV infection, along with 21 control patients. One or more comprehensive ophthalmologic examinations were performed on each patient. The frequency and etiology of visual impairment and other ophthalmologic problems were tabulated for each patient. Results: Nine of 42 (22%) patients in the symptomatic group had moderate to severe visual impairment in 16 eyes. Visual impairment was primarily due to optic atrophy in 6 of 16 (37%) eyes, macular scars in 2 of 16 (13%) eyes, and cortical visual impairment in 8 of 16 (50%) eyes. In comparison, none of 83 asymptomatic patients had severe visual impairment (P < .001). One asymptomatic patient had mild unilateral visual impairment caused by a macular scar. Strabismus developed in 12 of 42 (29%) symptomatic patients compared with 1 of 83 (1.2%) asymptomatic patients (P < .001). Conclusions: Visual impairment and strabismus are common in patients with symptomatic congenital CMV infection and rare in patients with asymptomatic congenital CMV infection. Visual impairment may be caused by cortical, optic nerve, and/or retinal abnormalities. Infants with symptomatic congenital CMV infection should undergo careful ophthalmologic screening and follow-up examinations. (J AAPOS 2000;4:110–6)

Section snippets

Methods

Since 1982, a long-term prospective study of ocular, auditory, and neurodevelopmental sequelae in children with congenital CMV infection has been conducted at Texas Children's Hospital and Texas Women's Hospital in Houston, Texas. From 1982 to 1992, all newborns were screened for congenital CMV by culture of the urine for virus. Those identified as infected were invited to participate in the study, along with control patients. After 1992, additional symptomatic patients have been referred to

Results

A total of 146 patients have undergone ophthalmologic examination, including 42 symptomatic patients, 83 asymptomatic patients, and 21 control patients (Table 1). Enrollment of control patients was limited by reluctance of parents to enroll their healthy children in a longitudinal study likely to last more than 20 years. In the symptomatic group, there were 22 males and 20 females. In the asymptomatic group, there were 45 males and 38 females, and in the control group, 16 males and 5 females.

Discussion

Congenital CMV infection is the most prevalent of the known congenital viral infections.1, 2, 3, 4 Cytomegalovirus is the largest member of the herpesvirus family. It consists of a double-stranded DNA core in an icosahedral capsule surrounded by amorphous material, which is, in turn, enclosed by a lipid envelope. The term cytomegalic inclusion disease is derived from the characteristic cells found on histopathologic examination, consisting of enlarged cells containing distinctive intranuclear

Conclusions

Visual impairment is common in patients with symptomatic congenital CMV infection. Cortical visual impairment and optic atrophy are the most common causes of severe visual impairment. Macular scars may produce visual impairment in a small number of patients. Additionally, because strabismus is common in symptomatic patients, strabismic amblyopia poses another risk to the visual status of this patient population. Ocular sequelae in asymptomatic patients with congenital CMV are uncommon.

Early

Acknowledgements

We would like to acknowledge Daniel Noyola, MD, for his help with the statistical analysis of the patient data.

The Congenital CMV Longitudinal Study Group includes: Frank Brown, MD, Francis Catlin, MD, David K. Coats, MD, Gail J. Demmler, MD, Jane Edmonds, MD, Daniel Franklin, MD, Jewel Greer, Carol Griesser, RN, Allison Istas, MPH, Judith Kozelle, Antone Laurente, PhD, Thomas Littman, PhD, Mary Murphy, Christopher Nelson, MD, Daniel Noyola, MD, Evelyn A. Paysse, MD, Alan Percy, MD, Sara Reis,

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Supported by the following sources: An unrestricted grant from Research to Prevent Blindness, Inc, New York, New York; The Woman's Hospital of Texas Research Foundation; Deafness Foundation; General Clinical Research Center, National Institutes of Health (NIH) MOI RR 001-88-33; and Mental Retardation Research Center NIH-CHHD5 P30 HD24064, ID No. HD 9301.

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Reprint requests: David K. Coats, MD, Texas Children's Hospital, 1102 Bates, No. 300, Houston, TX 77030 (e-mail: [email protected]).

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