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    How to manage retinal disease in pregnant patients

     

    Retinal vascular occlusive diseaseVision loss immediately after childbirth. Postpartum Purtcher-like retinopathy can occur within 24 hours after infants are delivered and is associated with a complicated pregnancy. The patients often experience severe bilateral visual loss. (Photos courtesy of Mark W. Johnson, MD)

    Postpartum Purtcher-like retinopathy, an arterial occlusive disorder that can occur within 24 hours after infants are delivered, is associated with a complicated pregnancy. The patients often experience severe bilateral visual loss.  Amniotic fluid embolism also can cause retinal arterial occlusions, but, while rare, is usually fatal, Dr. Rosenthal said.

    Retinal venous occlusions associated with pregnancy usually occur in the third trimester or during the postpartum period.

     

    Exacerbated retinal/choroidal diseases

    Pregnancy might exacerbate retinal/choroidal diseases, such as idiopathic central serous chorioretinopathy (ICSC) and diabetic retinopathy. Dr. Johnson explained that pregnancy is a known trigger of active episodes of ICSC, which are related to elevated serum cortisol levels.  In this setting, there is up to a 90% incidence of subretinal fibrin deposition.

    He advised that patients with ICSC be managed with observation alone if they are close to delivery and no fibrin is present close to the fovea, since ICSC is expected to resolve after delivery.

    However, in cases in which fibrin is present near the fovea, optical coherence tomography (OCT)-guided laser photocoagulation can be applied.  Fluorescein angiography and photodynamic therapy (PDT) should be avoided if possible.

    Dr. Johnson described the case of a physician, an obstetrician/gynecologist, who had progressive fibrin deposits late in the second trimester with a visual acuity of 20/60.  By five months after treatment with OCT-guided thermal laser photocoagulation, her vision had recovered to 20/20.

    Diabetic retinopathy

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