When hematology meets ophthalmology: Cytomegalovirus retinitis in pediatric stem cell recipients

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.