TY - JOUR
T1 - Long-term Visual and Ocular Sequelae in Patients with Congenital Cytomegalovirus Infection
AU - Jin, Haoxing Douglas
AU - Demmler-Harrison, Gail J.
AU - Coats, David K.
AU - Paysse, Evelyn A.
AU - Bhatt, Amit
AU - Edmond, Jane C.
AU - Yen, Kimberly G.
AU - Steinkuller, Paul
AU - Miller, Jerry
N1 - Funding Information:
The study was supported, in part, by the CMV Research Fund Donors at Baylor College of Medicine; the Woman's Hospital of Texas Research Foundation; the Office of Research Resources and the General Clinical Research Center for Children at Texas Children's Hospital and Baylor College of Medicine (NIH 5M0I RR00188-33); the Mental Retardation Research Center at Baylor College of Medicine (NIH-CHHD 5 P30 HD24064P); the Research to Prevent Blindness, Inc., New York, NY; the Deafness Foundation, Houston, TX; the Vale Ashe Foundation, Houston, TX; the Maddie's Mission Foundation, Katy, TX; the Naymola Charitable Foundation, Beaumont, TX; the Merck, Inc.; the American Pediatric Society-Society for Pediatric Research Summer Student Research Program (NIH-CHHD) and the Centers for Disease Control and Prevention (Cooperative Agreement FOA IP 10-006).
Funding Information:
The study was supported, in part, by the CMV Research Fund Donors at Baylor College of Medicine; the Woman’s Hospital of Texas Research Foundation; the Office of Research Resources and the General Clinical Research Center for Children at Texas Children’s Hospital and Baylor College of Medicine (NIH 5M0I RR00188-33); the Mental Retardation Research Center at Baylor College of Medicine (NIH-CHHD 5 P30 HD24064P); the Research to Pre-vent Blindness, Inc., New York, NY; the Deafness Foundation, Houston, TX; the Vale Ashe Foundation, Houston, TX; the Maddie’s Mission Foundation, Katy, TX; the Naymola Charitable Foundation, Beaumont, TX; the Merck, Inc.; the American Pediatric Society-Society for Pediatric Research Summer Student Research Program (NIH-CHHD) and the Centers for Disease Con-trol and Prevention (Cooperative Agreement FOA IP 10-006).
Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Background: Cytomegalovirus (CMV) is the most common congenital viral infection in the United States. Visual and ocular sequelae in adolescents and adults who are congenitally infected with CMV have not been well studied. Better understanding of the long-term visual and ocular sequelae can help with early detection, intervention and appropriate educational accommodations. Methods: This study evaluated 237 patients (77 symptomatic, 109 asymptomatic and 51 control) who underwent a series of age-appropriate ophthalmologic, audiologic and neurodevelopmental examinations from 1982 to 2013. The frequency and etiology of visual impairment and other nonophthalmologic findings were recorded for each patient. Ophthalmologic findings were tabulated, and risk factors for abnormalities were analyzed. Results: Fourteen of the 77 (18.2%) symptomatic and none of the asymptomatic and control subjects had severe visual impairments (P ≤ 0.006). Moderate visual impairment did not differ between symptomatic and asymptomatic subjects. Three asymptomatic subjects had retinal scars. The most common visual or ocular sequelae in the symptomatic group were strabismus (23.4%), chorioretinal scars (19.5%), cortical visual impairment (14.3%), nystagmus (14.3%) and optic nerve atrophy (11.7%). Three symptomatic patients had delayed visual deterioration because of later occurring retinal disorders: peripheral retinal scar, rhegmatogenous retinal detachment and Coats' disease. Conclusion: Symptomatic CMV patients experienced more ophthalmologic sequelae and significantly worse visual outcomes than asymptomatic CMV and control patients. Later occurring retinal disorders were found in symptomatic patients, and there is no clear evidence that CMV can reactivate in the retinas of children who were congenitally infected. Major risk factors for severe visual impairment included symptomatic status, optic nerve atrophy, chorioretinitis, cortical visual impairment and sensorineural hearing loss.
AB - Background: Cytomegalovirus (CMV) is the most common congenital viral infection in the United States. Visual and ocular sequelae in adolescents and adults who are congenitally infected with CMV have not been well studied. Better understanding of the long-term visual and ocular sequelae can help with early detection, intervention and appropriate educational accommodations. Methods: This study evaluated 237 patients (77 symptomatic, 109 asymptomatic and 51 control) who underwent a series of age-appropriate ophthalmologic, audiologic and neurodevelopmental examinations from 1982 to 2013. The frequency and etiology of visual impairment and other nonophthalmologic findings were recorded for each patient. Ophthalmologic findings were tabulated, and risk factors for abnormalities were analyzed. Results: Fourteen of the 77 (18.2%) symptomatic and none of the asymptomatic and control subjects had severe visual impairments (P ≤ 0.006). Moderate visual impairment did not differ between symptomatic and asymptomatic subjects. Three asymptomatic subjects had retinal scars. The most common visual or ocular sequelae in the symptomatic group were strabismus (23.4%), chorioretinal scars (19.5%), cortical visual impairment (14.3%), nystagmus (14.3%) and optic nerve atrophy (11.7%). Three symptomatic patients had delayed visual deterioration because of later occurring retinal disorders: peripheral retinal scar, rhegmatogenous retinal detachment and Coats' disease. Conclusion: Symptomatic CMV patients experienced more ophthalmologic sequelae and significantly worse visual outcomes than asymptomatic CMV and control patients. Later occurring retinal disorders were found in symptomatic patients, and there is no clear evidence that CMV can reactivate in the retinas of children who were congenitally infected. Major risk factors for severe visual impairment included symptomatic status, optic nerve atrophy, chorioretinitis, cortical visual impairment and sensorineural hearing loss.
KW - congenital cytomegalovirus
KW - cytomegalovirus
KW - long-term
KW - sequelae
KW - visual
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U2 - 10.1097/INF.0000000000001599
DO - 10.1097/INF.0000000000001599
M3 - Article
C2 - 28399055
AN - SCOPUS:85017441368
VL - 36
SP - 877
EP - 882
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
SN - 0891-3668
IS - 9
ER -