Al-Battashy A, Al-Farsi N. When hematology meets ophthalmology: Cytomegalovirus retinitis in pediatric stem cell recipients. World J Stem Cells 2025; 17(7): 107153 [DOI: 10.4252/wjsc.v17.i7.107153]
Corresponding Author of This Article
Nouf Al-Farsi, FRCS, MD, Chief Physician, Department of Ophthalmology, Sultan Qaboos University, P.O. Box 38 P.C. 123 Al-Khoud, Muscat 123, Oman. noufalfarsi@gmail.com
Research Domain of This Article
Ophthalmology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Stem Cells. Jul 26, 2025; 17(7): 107153 Published online Jul 26, 2025. doi: 10.4252/wjsc.v17.i7.107153
When hematology meets ophthalmology: Cytomegalovirus retinitis in pediatric stem cell recipients
Aisha Al-Battashy, Nouf Al-Farsi
Aisha Al-Battashy, Department of Ophthalmology, Oman Medical Specialty Board, Muscat 132, Oman
Nouf Al-Farsi, Department of Ophthalmology, Sultan Qaboos University, Muscat 123, Oman
Co-first authors: Aisha Al-Battashy and Nouf Al-Farsi.
Author contributions: Al-Battashy A and Al-Farsi N wrote manuscript and are co-first authors of this article; Al-Farsi N reviewed manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nouf Al-Farsi, FRCS, MD, Chief Physician, Department of Ophthalmology, Sultan Qaboos University, P.O. Box 38 P.C. 123 Al-Khoud, Muscat 123, Oman. noufalfarsi@gmail.com
Received: March 17, 2025 Revised: May 11, 2025 Accepted: June 19, 2025 Published online: July 26, 2025 Processing time: 129 Days and 21.2 Hours
Abstract
Cytomegalovirus (CMV) retinitis is a significant yet infrequent complication in pediatric hematopoietic stem cell transplant recipients, occurring in approximately 4% of cases. Its presentation typically coincides with immune reconstitution, between 6 weeks to 6 months post-transplant, emphasizing the need for timely detection. Symptoms often develop insidiously, underscoring the role of fundus examinations during episodes of CMV viremia. However, the low incidence challenges the necessity of routine screenings, as they may strain clinical resources without clear benefits to patient outcomes. Management includes systemic and intravitreal antivirals, such as ganciclovir and foscarnet, and adoptive T-cell therapy for refractory cases. Tailored follow-up strategies are crucial, with considerations for lesion activity and CMV viremia status to determine the duration of therapy. Baseline and post-transplant screenings remain a topic of debate, with evolving guidelines needed to balance patient safety and clinical feasibility. Future research is needed to address optimal screening intervals and investigate the role of pre-existing CMV serostatus in transplant eligibility and outcomes.
Core Tip: Cytomegalovirus retinitis in pediatric hematopoietic stem cell transplant recipients is a complex and potentially devastating complication, but with early detection and appropriate management, outcomes can be significantly improved. Screening protocols continue to evolve, with the emphasis on identifying high-risk patients during periods of immune reconstitution. Management of cytomegalovirus retinitis in pediatric patients post-hematopoietic stem cell transplant requires a comprehensive approach that balances effective viral suppression with the mitigation of drug-related toxicities. Antiviral therapies, whether systemic, intravitreal, or implantable, remain central to treatment. Adjunctive immunotherapies, particularly adoptive T-cell therapy, offer promising outcomes in refractory cases. Emerging modalities, including high-dose intravitreal regimens and novel antivirals, hold potential for future advancements. Individualized treatment plans, guided by patient-specific risk factors and disease severity, are crucial to optimize outcomes and preserve vision in this vulnerable population.
