Cytomegalovirus retinitis in immunosuppressed children

PURPOSE: To describe the ocular and systemic features of children with cyto megalovirus retinitis and their disease outcomes. METHODS: Review of all cases of cytomegalovirus retinitis diagnosed or trea ted at a tertiary care pediatric hospital during a 10-year period. RESULTS: Nine immunocompromised children younger than 16 years were diagnos ed as having cytomegalovirus retinitis, The underlying causes of immunocomp romise were severe combined immunodeficiency syndrome (n = 2), severe combi ned immunodeficiency syndrome after bone marrow transplantation (n = 1), ac quired immunodeficiency syndrome (AIDS) (n = 2), AIDS and previous bone mar row transplantation for leukemia (n = 1), immunosuppressive therapy after r enal transplantation (n = 1), chemotherapy for leukemia (n = I), and congen ital cytomegalovirus infection (n = I). Nine children (56%) had symptomatic extraocular cytomegalovirus infection, Only two children reported visual s ymptoms with cytomegalovirus retinitis at initial examination. Cytomegalovi rus retinitis was bilateral in eight children (89%) and involved the poster ior pole in at least one eye of all nine children. Four children (44%) died within 10 months of being diagnosed with cytomegalovirus retinitis, The re maining five children were alive, with follow-up ranging from 14 to 70 mont hs, Successful bone marrow transplantation in one child and discontinuation of immunosuppressive medications in two children improved systemic immune function and permitted discontinuation of anticytomegaloviral therapy, CONCLUSION: Pediatric cytomegalovirus retinitis is often asymptomatic and b ilateral and involves the posterior pole at initial examination. Recovery o f systemic immune function may occur in some children. Evaluation of childr en at risk and prompt treatment of cytomegalovirus retinitis are important to prevent long term visual morbidity. (C) 1999 by Elsevier Science Inc. Al l rights reserved.