Seeing the Bigger Picture: Cytomegalovirus Retinitis Screening in Pediatric Hematopoietic Stem Cell Transplant Patients.

INTRODUCTION

Cytomegalovirus (CMV) reactivation poses significant risks in pediatric patients undergoing allogeneic hematopoietic stem cell transplant (HSCT), including the potential for CMV retinitis, which can cause severe ocular complications. A previously published CMV retinitis screening protocol called for intensive and frequent screening exams with retinal photography.

OBJECTIVES

To evaluate the prevalence and incidence of CMV retinitis, assess institutional adherence to previously published protocol, and determine the impact and efficacy of the CMV retinitis screening protocol.

METHODS

Retrospective cohort study of 228 patients treated at Children's Hospital Colorado from 2015 to 2021.

RESULTS

Among allogeneic HSCT patients, 25.4% developed CMV viremia, and of these, three developed CMV retinitis (mean time from viremia to retinitis diagnosis: 53.6 days). Adherence to the protocol was suboptimal; 27.6% of patients with CMV viremia underwent recommended dilated fundus exam and photography within 2 weeks of diagnosis. Despite this, no significant long-term ocular complications were noted, suggesting limited benefit from early and frequent screenings.

CONCLUSIONS

Within this cohort, 5.2% of patients with CMV viremia developed retinitis, and 15.4% of all patients developed at least one ocular complication. Universal pre-HSCT screening with fundus photography did not result in early detection of retinitis. In this cohort, CMV retinitis did not develop until 5-12 weeks after viremia was detected, making early screening unlikely to have clinical significance. This study highlights the necessity of ocular screenings-as all patients with CMV retinitis were asymptomatic-but advocates for a more streamlined approach to improve adherence and protect ocular health during the vulnerable post-transplant period.