How to manage retinal disease in pregnant patients
Drs. Johnson and Rosenthal offered several pearls for treating pregnant patients with retinal diseases.
For intravitreal injection, triamcinolone is safe in this patient population. Although small case series have reported that anti-VEGF agents had no harmful effects on the fetus, no large studies have addressed this issue and there is no available fetal safety data that compared anti-VEGF agents.
Anti-VEGF agents should be administered to pregnant women only if absolutely necessary, and pregnancy testing should be performed in women of child-bearing age, the doctors recommended.
When considering angiography, they pointed out that fluorescein dye crosses the placenta and is present in breast milk for 72 hours. No reports have documented any adverse effects on the fetus.
Indocyanine green dye, however, does not cross the placenta and is used in pregnant women for non-ophthalmic indications. It is advisable that OCT or OCT-angiography be used instead of invasive angiography wherever possible.
Regarding surgery, such as vitreoretinal procedures, elective surgeries should be avoided during pregnancy. In cases in which surgery is necessary, the obstetrical team should be involved, and local rather than general anesthesia is preferred. Lidocaine is considered safe for use during pregnancy, whereas bupivacaine and mepivacaine should be avoided.
No data are available regarding gestational exposure to PDT with verteporfin. Whenever possible, thermal laser should be used instead of PDT.
Drs. Johnson and Rosenthal emphasized that retinal specialists must be armed with knowledge about the changes in pregnancy and the manner in which retinal diseases affect these patients in order to effectively treat this population.