Risk factors for recurrence of cytomegalovirus retinitis in children receiving allogeneic hematopoietic stem cell transplantation

Abstract

Introduction. Cytomegalovirus retinitis (CMVR) is a necrotizing disease of the retina that can cause irreversible blindness. An increase in the number of CMVR episodes increases the likelihood of developing irreversible blindness. Reducing the risk of CMVR recurrence will improve the effectiveness of visual rehabilitation for this category of patients. Aim: To study the patterns and risk factors for the development of CMVR recurrence in children who are recipients of hematopoietic stem cells.

Materials and methods. The study included 37 patients aged 0 to 21 years (62 eyes) who had undergone CMVR and hematopoietic stem cell transplantation and received a series of intravitreal injections (IVI) of antiviral drugs. CMVR recurrences occurred in seven patients. In 3 patients, there was a recurrence in 1 eye, in 4 — in both eyes. Of the 62 eyes, 51 had no recurrences, 6 had one recurrence, and 5 had more than one recurrence. A recurrence was diagnosed in 23 out of 81 episodes. Remission was considered achieved when the absence of cytomegalovirus DNA was confi rmed in a sample of aqueous humor taken from the anterior chamber of the eye and/or upon complete healing of CMVR lesions as determined by ophthalmoscopy.

Results. Discontinuation of IV antiviral drugs based on negative aqueous humor PCR results reduces the likelihood of recurrence by more than 16 times compared to a decision based on ophthalmoscopic data (p-value = 0.011) and by more than 2 times compared with non-zero PCR results.

Conclusion. The recurrent nature of the course of CMVR is associated with the replication of virus copies inside the eye. Elimination of copies of the virus from the intraocular fl uid reduces the likelihood of developing a CMVR recurrence.