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Presentation and management of cytomegalovirus retinitis in immunocompromised children
Author(s) -
Denier C.,
Robert M.,
Adjadj E.,
Michel S.,
Aymard P.A.,
BremondGignac D.
Publication year - 2016
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2016.0622
Subject(s) - medicine , cytomegalovirus retinitis , foscarnet , retinitis , posterior pole , ophthalmology , presentation (obstetrics) , posterior segment of eyeball , surgery , cytomegalovirus , aqueous humor , clinical endpoint , visual acuity , pediatrics , ganciclovir , human immunodeficiency virus (hiv) , randomized controlled trial , human cytomegalovirus , viral disease , herpesviridae , virus , family medicine , virology
Purpose Cytomegalovirus retinitis in children is poor known and his management remains controversial. The objective of this study is to provide a precise clinical description and set a treatment protocol for a better management of these patients. Methods Retrospective study including all children's eyes with primary immune deficiency (PID) patients with CMV retinitis confirmed by PCR on aqueous humor. The treatment protocol consisted of: an anti‐viral treatment with intravitreal injection (IVT) associated with general treatment. The primary endpoint was the good response to treatment defined by a quantifiable vision at the end of treatment. Results Fifteen eyes of 8 children aged 6 months to 10 years were included, of 156 children transplanted for PID. Each eye received 4.7 ± 2.5 IVT of Gancyclovir (12/15) or Foscarnet (3/15). The time between IVT was 4, 8 ± 2 days. A systemic treatment was initiated. Eight eyes were placed in the ‘good recovery’ group (BR) and seven eyes of four patients in the ‘poor recovery’ group (MR). In the BR group's initial involvement was peripheral or sectorial, while in the MR group achievement was broadcast for four eyes or sectoral reached the posterior pole for three eyes. The number of IVT by eye and the time between IVT were not different between the groups as well as systemic therapy. At the end of treatment in the BR group the posterior pole was normal for five eyes or showed a para‐macular scar for three eyes. In the MR group, five eyes showed diffuse fibrosis and two macular scar. Conclusions Visual prognosis seems related to the extent of the initial damage, the need for regular checks of the FO in children at risk is paramount. Regarding the treatment protocol, an average of four ganciclovir IVT to two per week without exceeding six IVT, combined with the general treatment appears to be an effective protocol.