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April 2004

An Epidemiological and Clinical Study of Ocular Manifestations of CongenitalRubella Syndrome in Omani Children

Author Affiliations

From the Eye and Ear Health Care Programme, Ministry of Health (DrKhandekar); Department of Disease Surveillance and Disease Control, Ministryof Health (Dr Al Awaidy); Department of Ophthalmology, Sultan Qaboos UniversityHospital (Dr Ganesh); and Department of Disease Surveillance and Disease Control,Ministry of Health (Dr Bawikar), Muscat, Oman. The authors have no relevantfinancial interest in this article.

Arch Ophthalmol. 2004;122(4):541-545. doi:10.1001/archopht.122.4.541

Objective  To conduct a follow-up study in patients with congenital rubella syndrome(CRS) in Oman and analyze the prevalence of ophthalmic disorders and associatedsystemic problems.

Methods  This historical prospective cohort study included review of 32 survivingpatients with CRS reported by the surveillance system in Oman from 1987 through2002. All patients underwent a complete ophthalmic examination that includedvisual acuity estimation, refraction and anterior and posterior segment evaluation,and intraocular pressure measurement. Pediatric and otorhinolaryngologic consultationswere also performed.

Results  The age-adjusted prevalence of CRS in Oman was 73.2 per million in theOmani population younger than 20 years, and the incidence was 0.6 per 1000live births. Cataract, retinitis, microphthalmos, and glaucoma were observedin 11, 16, 6, and 4 patients, respectively. Keratoconus, corneal hydrops,and spontaneous resorption of lens were found in 1 patient each. Vision testingwas possible in 16 children; 4 were bilaterally blind. Patients who had undergoneeye surgery had significantly lower visual acuity, as compared with thosewho had not undergone surgery (relative risk 2.53; 95% confidence interval,1.07-6.13). Among the 11 patients with CRS with cataract, we found hearingloss, cardiac anomalies, and neuropsychologic anomalies in 7, 4, and 6 children,respectively.

Conclusions  Congenital rubella syndrome has a wide variety of severe ophthalmicand systemic complications. High clinical vigilance for signs of CRS and regularobservation of surviving patients with CRS is desirable. In patients withcataract, the functional results of surgery, despite state-of-the-art ophthalmiccare, continue to be poor. Because of a high prevalence of visual, audiologic,and neurologic disabilities, surviving patients with CRS pose a burden onthe medical and social communities. Emphasis in management ought to be preventionof CRS through effective immunization programs.