Ophthalmologic findings in children with congenital cytomegalovirus infection

Background: Cytomegalovirus (CMV) infection is the mast common congenital v iral infection in the United States, affecting 0.5% to 2% of live births. A pproximately 90% of infected infants are asymptomatic at birth. We undertoo k this study to determine the incidence and etiology of visual impairment a nd other ophthalmologic abnormalities in children with congenital CMV infec tion. Methods:We prospectively evaluated 42 symptomatic and 83 asymptomatic children with congenital CMV infection, along with 21 control patients. On e or more comprehensive ophthalmologic examinations were performed on each patient. The frequency and etiology of visual impairment and other ophthalm ologic 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 impai rment in 8 of 16 (50%) eyes. In comparison, none of 83 asymptomatic patient s had severe visual impairment (P < .001). One asymptomatic patient had mil d unilateral visual impairment caused by a macular scar. Strabismus develop ed in 12 of 42 (29%) symptomatic patients compared with 1 of 83 (1.2%) asym ptomatic 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 m ay be caused by cortical, optic nerve, and/or retinal abnormalities. Infant s with symptomatic congenital CMV infection should undergo careful ophthalm ologic screening and follow-up examinations. (J AAPOS 2000;4:110-6).