Abstract
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.