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Erkan Pota Ç, Apaydın KC. Retinal and choroidal microvascular changes during pregnancy detected with OCTA. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e357-e364. [PMID: 37393067 DOI: 10.1016/j.jcjo.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/05/2023] [Accepted: 06/05/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To investigate choroidal and retinal blood flow and thickness changes using optical coherence tomography and optical coherence tomography angiography during pregnancy. DESIGN Prospective and case-control study between June 2020 and June 2021. METHODS This prospective study included 41 eyes of 41 pregnant females and 45 eyes of 45 healthy nonpregnant females. Ocular perfusion pressure, retinal thickness, choroidal thickness, foveal avascular zone (FAZ) area, superficial and deep capillary plexuses (SCP and DCP, respectively), vessel density (VD), and choriocapillaris (CC) VD measurements were evaluated with optical coherence tomography and optical coherence tomography angiography. RESULTS There was no significant difference in ocular perfusion pressure, retinal thickness, and choroidal thickness during pregnancy. The FAZ area increased as the gestational weeks progressed (p = 0.011). The FAZ area in the first trimester was significantly smaller than that in the control group (p = 0,029). A decrease in the central SCP and DCP VD in the third trimester and an increase in the CC VD during pregnancy were detected (p = 0.01, p < 0.001, and p < 0.001, respectively). We observed an increase in mean VD for both the SCP and DCP in the second trimester (p = 0.02 and p = 0.027, respectively). In the second and third trimesters, the SCP and DCP VD values were found to be significantly higher than in the control group. During the pregnancy, a significant increase in CC VD was detected. CONCLUSION This is the first prospective study in the literature that evaluates the measurements in all trimesters of pregnancy with optical coherence tomography angiography. We observed significant retinal and choroidal microvascular changes between trimesters of pregnancy and when compared with healthy females.
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Affiliation(s)
- Çisil Erkan Pota
- Department of Ophthalmology, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
| | - Kadri Cemil Apaydın
- Department of Ophthalmology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Feenstra HMA, van Dijk EHC, Cheung CMG, Ohno-Matsui K, Lai TYY, Koizumi H, Larsen M, Querques G, Downes SM, Yzer S, Breazzano MP, Subhi Y, Tadayoni R, Priglinger SG, Pauleikhoff LJB, Lange CAK, Loewenstein A, Diederen RMH, Schlingemann RO, Hoyng CB, Chhablani JK, Holz FG, Sivaprasad S, Lotery AJ, Yannuzzi LA, Freund KB, Boon CJF. Central serous chorioretinopathy: An evidence-based treatment guideline. Prog Retin Eye Res 2024; 101:101236. [PMID: 38301969 DOI: 10.1016/j.preteyeres.2024.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.
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Affiliation(s)
- Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Suzanne Yzer
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA; Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Siegfried G Priglinger
- Department of Ophthalmology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Laurenz J B Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Clemens A K Lange
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Ocular Angiogenesis Group, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jay K Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York, USA; Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
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Erkan Pota Ç, Çetinkaya Yaprak A. Evaluation of anterior segment parameters between pregnancy trimesters and postpartum with pentacam scheimflug ımaging: a prospective study. Int Ophthalmol 2024; 44:268. [PMID: 38913127 PMCID: PMC11196334 DOI: 10.1007/s10792-024-03173-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 06/15/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE To evaluate the effect of pregnancy on the anterior chamber, corneal parameter, and intraocular pressure measurements; and compare the results between trimesters, postpartum and non-pregnant healthy age-matched women. METHODS This prospective study included 41 pregnant women and 53 non-pregnant women. Four measurements were taken from the pregnant women, in each trimester and postpartum third month, and once from the control group. Of the individuals included in the study, anterior chamber depth (ACD), anterior chamber volume (ACV), K1 (flat keratometry), K2 (steep keratometry), Kmean (mean value of K1 and K2), anterior chamber angle (ACA), central corneal thickness (CCT), thinnest corneal thickness (TCT), astigmatism value (AST), corneal volume (CV), biometry, axial length (AL), spherical equivalent (SFEQ), intraocular lens power (ILP), VA (visual acuity) datas were recorded. RESULTS We observed a statistically significant decrease in K2, CCT, ACD, AL and CV in the postpartum period (p = 0.025, p < 0.001, p = 0.029, p = 0.005, p = 0.004 respectively) and a statistically significant increase in ACV, CCT, and TCT as the gestational week progressed in the pregnant group (p = 0.007, p < 0.001, p = 0.025, respectively). A statistically significant decrease in IOP towards to the third trimester, and an increase in the postpartum period was observed (p < 0.001). We did not observe statistically significant changes in K1, Kmean, AST, ACA, VA, ILP, and SFEQ values. CONCLUSION It is important to investigate the physiological changes that may occur during pregnancy, distinguish them from pathological changes, and avoid unnecessary treatment. We consider that it's also important to guide the timing of anterior segment surgeries such as cataract and refractive surgery and to prescribe glasses/contact lenses.
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Affiliation(s)
- Çisil Erkan Pota
- Department of Ophthalmology, Antalya Manavgat State Hospital, Manavgat, Antalya, Turkey
| | - Aslı Çetinkaya Yaprak
- Department of Ophthalmology, Akdeniz University Faculty of Medicine, 07070, PınarbaşıMah., Konyaaltı, Antalya, Turkey.
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Kogo T, Muraoka Y, Ishikura M, Nishigori N, Akiyama Y, Ueda-Arakawa N, Miyata M, Ooto S, Hata M, Takahashi A, Miyake M, Tsujikawa A. Pigment Epithelial Detachment and Leak Point Locations in Central Serous Chorioretinopathy. Am J Ophthalmol 2024; 261:19-27. [PMID: 38244961 DOI: 10.1016/j.ajo.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
PURPOSE To examine the associations between the vortex vein characteristics and locations of the pigment epithelial detachment (PED) and leak point in patients with central serous chorioretinopathy (CSC). DESIGN Observational case series. METHODS We evaluated 116 eyes of 104 patients with CSC. The PED and leak point locations were superimposed over the choroidal en face images using widefield swept-source optical coherence tomography and fluorescein angiography. We defined the draining areas of the superior and inferior vortex veins and analyzed their associations with the PED and leak point locations. RESULTS One of the 116 eyes with a unique irrigation pattern dominated by the nasal vortex vein was excluded from the analysis. Sixty-nine (60%) of the remaining 115 eyes exhibited asymmetry between the superior and inferior vortex veins. PEDs and leak points were in the vortex vein draining area with greater dilation in 66 (96%) of 69 eyes with asymmetry, and none (0%) were in the opposite areas. Both the PEDs and leak points showed significant differences in their distributions (P < .001, respectively). Additionally, 74% of PEDs and 84% of leak points were located upstream of the vortex vein draining areas, whose frequency was significantly higher compared to other areas (P < .001, respectively). CONCLUSION PED and leak point spatial distributions corresponded with the most terminal part of the dilated vortex veins, suggesting that blood flow disturbances, such as stasis within the affected vortex veins, may be essential in the pathogenesis of CSC.
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Affiliation(s)
- Takahiro Kogo
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Masaharu Ishikura
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naomi Nishigori
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Akiyama
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoko Ueda-Arakawa
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sotaro Ooto
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Hata
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Takahashi
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
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Erkan Pota Ç, Doğan ME, Alkan Bülbül G, Sanhal CY, Pota A. Optical coherence tomography angiography assessment of retinochoroidal microcirculation differences in preeclampsia. Photodiagnosis Photodyn Ther 2024; 46:104004. [PMID: 38342388 DOI: 10.1016/j.pdpdt.2024.104004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/14/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND To investigate microvascular changes in pregnant women with preeclampsia using optical coherence tomography angiography (OCTA) and compare the results with healthy pregnant and non-pregnant subjects. METHODS Superficial capillary plexus (SCP), deep capillary plexus (DCP) choriocapillaris (CC) vessel density (VD) and foveal avascular zone area (FAZ), retina, retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL) and the choroidal thickness were examined and compared in preeclamptic pregnant (group 1), healthy pregnant women (group 2) and non-pregnant, age-matched female controls (group 3). The correlations of the parameters with each other and with blood pressure were evaluated. RESULTS No significant difference was found between the groups when retinal, RNFL and GCL thickness values (p> 0.05). The choroidal thickness values were significantly lower in group 1 than in group 2 (p = 0.029). The central foveal VD of the SCP and DCP was significantly lower in group 1 compared to groups 2 and 3 (p = 0.03, p< 0.01 respectively). The mean VD of the SCP was significantly higher in groups 1 and 2 than in group 3 (p = 0.01). The FAZ area was statistically significantly lower in group 3 than in group 2 (p = 0.032). The CC VD was lower in group 3 compared to the other groups in all measurements (p < 0.01).The FAZ area was positively correlated with systolic blood pressure in group 1. CONCLUSION The use of OCTA, a non-invasive imaging technique, to assess the retinal microcirculation appears to have the potential to in the early diagnosis or follow up in preeclampsia before signs of hypertensive retinopathy.
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Affiliation(s)
- Çisil Erkan Pota
- Department of Ophthalmology, Manavgat State Hospital, Antalya, Turkey.
| | - Mehmet Erkan Doğan
- Department of Ophthalmology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Gül Alkan Bülbül
- Department of Obstetrics and Gynecology, Division of Perinatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Cem Yaşar Sanhal
- Department of Obstetrics and Gynecology, Division of Perinatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ali Pota
- Department of Obstetrics and Gynecology, Antalya Kepez State Hospital, Antalya, Turkey
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Madike R, Cugati S, Qin Q, Chen C. Pregnancy and the eye: What do we need to watch out for? A review. Clin Exp Ophthalmol 2024; 52:234-247. [PMID: 38214050 DOI: 10.1111/ceo.14346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
Pregnancy causes changes in all body systems, including the eye. The eye can undergo physiological and pathological changes in pregnancy. Some changes exacerbate pre-existing eye conditions while other conditions manifest for the first-time during pregnancy. Early recognition and management are essential to prevent sight threatening complications. In addition, some obstetric complications can be associated with ophthalmic signs. Prompt recognition of these eye findings may be life saving for both the mother and the foetus. The aim of this article is to present potential ocular complications in pregnancy and outline the appropriate management to preserve sight and maintain maternal and foetal safety. The safety of the use of common ophthalmological medications will also be discussed.
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Affiliation(s)
- Reema Madike
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Sudha Cugati
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, Modbury Hospital, South Australia Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Queena Qin
- Department of Ophthalmology, Modbury Hospital, South Australia Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Celia Chen
- Department of Ophthalmology, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
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Doğan ME, Erkan Pota Ç. Investigation of the effects of gestational diabetes and hypertension on retinal and choroidal microvascular circulation using swept-source optical coherence tomography angiography. Microvasc Res 2024; 152:104622. [PMID: 37981229 DOI: 10.1016/j.mvr.2023.104622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE The aim of this study was to investigate the microvascular changes in the retina and choroid in gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) and to compare the results with those of healthy pregnant subjects. METHODS Twenty-nine pregnant subjects with coexisting GDM and PIH (group 1) and 36 healthy pregnant subjects (group 2) were enrolled in the study. All subjects were examined by optical coherence tomography (OCT) and angiography (OCTA). The retina, retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), choroidal thickness (CT), superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC) vascular density (VD), and foveal avascular zone (FAZ) were measured. RESULTS We observed that the values of CT and VD were lower in group 1 than in group 2. No significant difference was found between groups in RT, FAZ area and CC VD. SCP and DCP VD values were higher in group 2 in all quadrants. We observed a significant increase in FAZ area and CC VD with increasing systolic blood pressure. No correlation was observed between diastolic blood pressure and FBS with other parameters. In group 1, FAZ area was significantly higher in the diet-treated group than in the insulin-treated group. CONCLUSION Monitoring and treatment of pregnant women with PIH and GDM is important because of the risks that may occur during pregnancy. We believe that changes in microvascular circulation can be detected noninvasively with OCTA, even in the absence of clinical or retinal findings.
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Affiliation(s)
- Mehmet Erkan Doğan
- Department of Ophthalmology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Çisil Erkan Pota
- Department of Ophthalmology, Manavgat State Hospital, Antalya, Turkey.
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Rosu LM, Prodan-Bărbulescu C, Maghiari AL, Bernad ES, Bernad RL, Iacob R, Stoicescu ER, Borozan F, Ghenciu LA. Current Trends in Diagnosis and Treatment Approach of Diabetic Retinopathy during Pregnancy: A Narrative Review. Diagnostics (Basel) 2024; 14:369. [PMID: 38396408 PMCID: PMC10887682 DOI: 10.3390/diagnostics14040369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Diabetes mellitus during pregnancy and gestational diabetes are major concerns worldwide. These conditions may lead to the development of severe diabetic retinopathy during pregnancy or worsen pre-existing cases. Gestational diabetes also increases the risk of diabetes for both the mother and the fetus in the future. Understanding the prevalence, evaluating risk factors contributing to pathogenesis, and identifying treatment challenges related to diabetic retinopathy in expectant mothers are all of utmost importance. Pregnancy-related physiological changes, including those in metabolism, blood flow, immunity, and hormones, can contribute to the development or worsening of diabetic retinopathy. If left untreated, this condition may eventually result in irreversible vision loss. Treatment options such as laser therapy, intravitreal anti-vascular endothelial growth factor drugs, and intravitreal steroids pose challenges in managing these patients without endangering the developing baby and mother. This narrative review describes the management of diabetic retinopathy during pregnancy, highlights its risk factors, pathophysiology, and diagnostic methods, and offers recommendations based on findings from previous literature.
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Affiliation(s)
- Luminioara M. Rosu
- Department of Anatomy and Embryology, Victor Babeș University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (L.M.R.); (A.L.M.); (R.I.); (F.B.)
| | - Cătălin Prodan-Bărbulescu
- Department of Anatomy and Embryology, Victor Babeș University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (L.M.R.); (A.L.M.); (R.I.); (F.B.)
| | - Anca Laura Maghiari
- Department of Anatomy and Embryology, Victor Babeș University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (L.M.R.); (A.L.M.); (R.I.); (F.B.)
| | - Elena S. Bernad
- Department of Obstetrics and Gynecology, Victor Babeș University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, Victor Babeș University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Automatic Control and Applied Informatics, Politehnica University, 300223 Timisoara, Romania;
| | - Robert L. Bernad
- Department of Automatic Control and Applied Informatics, Politehnica University, 300223 Timisoara, Romania;
| | - Roxana Iacob
- Department of Anatomy and Embryology, Victor Babeș University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (L.M.R.); (A.L.M.); (R.I.); (F.B.)
- Discipline of Radiology and Medical Imaging, Victor Babeș University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania;
| | - Emil Robert Stoicescu
- Discipline of Radiology and Medical Imaging, Victor Babeș University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania;
- Research Center for Pharmaco-Toxicological Evaluations, Victor Babeș University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Florina Borozan
- Department of Anatomy and Embryology, Victor Babeș University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (L.M.R.); (A.L.M.); (R.I.); (F.B.)
| | - Laura Andreea Ghenciu
- Department of Functional Sciences, Victor Babeș University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania;
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Kaur A, Kumar R, Sharma A. Diabetic Retinopathy Leading to Blindness- A Review. Curr Diabetes Rev 2024; 20:e240124225997. [PMID: 38275038 DOI: 10.2174/0115733998274599231109034741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 01/27/2024]
Abstract
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes that damages the retina, leading to blindness. People with type 1 diabetes are at greater risk of developing DR than people with type 2 diabetes. Diabetic retinopathy may be divided into two primary categories: Proliferative diabetic retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR). There are multiple risk factors for the onset and progression of diabetic retinopathy, such as hypertension, obesity, smoking, duration of diabetes, and genetics. Numerous investigations have evaluated the levels of a wide range of inflammatory chemokines within DR patients' serum, vitreous, and aqueous fluids. In diabetic retinopathy, the vitreous fluid exhibited rises in angiogenic factors like platelet-derived growth factor (PDGF) or vascular endothelial growth factor (VEGF) or declines in antiangiogenic factors like pigment epithelium-derived factor (PEDF). For prevention of diabetic retinopathy, more physical activity as well as less sedentary behavior were linked to a reduced likelihood of DR. Supplementing with nutraceuticals containing vitamins (B1, B2, B6, B12, C, D, E, and l-methyl folate) and mineral (zinc) can help decrease or avoid an outbreak of DR. Only laser photocoagulation and Anti-vascular endothelial growth factor (Anti-VEGF) injections are advised as favorable therapies in severe retinopathy. When it comes to treating DR's VEGF levels, inflammation, oxidative stress, apoptosis, and angiogenesis, Traditional Chinese medicine (TCM) has an excellent future.
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Affiliation(s)
- Amandeep Kaur
- Department of Pharmacy Practice, ISF College of Pharmacy, Moga, Punjab, India
| | - Ranjeet Kumar
- Department of Pharmacy Practice, ISF College of Pharmacy, Moga, Punjab, India
| | - Amit Sharma
- Department of Pharmacy Practice, ISF College of Pharmacy, Moga, Punjab, India
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10
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Clarke K, Webster L, Althauser S, Anderson J, Stratton I, Brackenridge A, Mann SS. The risk of development and progression of diabetic retinopathy in a group of ethnically diverse pregnant women with diabetes attending three regional Diabetic Eye Screening Programs in the UK. Eye (Lond) 2024; 38:179-184. [PMID: 37419960 PMCID: PMC10764873 DOI: 10.1038/s41433-023-02655-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND/OBJECTIVES Currently, all pregnant women with diabetes are asked to attend screening at least twice during pregnancy, even if no retinopathy is detected in early pregnancy. We hypothesise that for women with no diabetic retinopathy in early pregnancy, the frequency of retinal screening may be safely reduced. SUBJECTS/METHODS In this retrospective cohort study, data for 4718 pregnant women attending one of three UK Diabetic Eye Screening (DES) Programmes between July 2011 and October 2019 was extracted. The women's UK DES grades at 13 weeks gestation (early pregnancy) and 28 weeks gestation (late pregnancy) were recorded. Descriptive statistics were used to report baseline data. Ordered logistic regression was used to control for covariates, such as age, ethnicity, diabetes duration, and diabetes type. RESULTS Of the women with grades recorded for both early and late pregnancy, a total of 3085 (65.39%) women had no retinopathy in early pregnancy, and 2306 (74.7%) of these women did not develop any retinopathy by 28 weeks. The number of women without retinopathy in early pregnancy who developed referable retinopathy was 14 (0.45%), none of whom required treatment. Diabetic Retinopathy in early pregnancy remained a significant predictor of DES grade in late pregnancy when covariates of Age, Ethnicity, and Diabetes Type were controlled for (P < 0.001). CONCLUSIONS In summary, this study has demonstrated that the burden of managing diabetes for pregnant mothers may be safely reduced by limiting the number of diabetic eye screening appointments in women who have no retinal changes in early pregnancy. Screening of women with retinopathy in early pregnancy should continue in line with current UK guidance.
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Affiliation(s)
- Kirsty Clarke
- Guy's and St Thomas' Hospital NHS Trust, London, England.
- Imperial College London, London, England.
| | - Laura Webster
- South East London Diabetic Eye Screening Programme, London, England
| | - Susanne Althauser
- North Central London Diabetic Eye Screening Programme, London, England
| | - John Anderson
- North East London Diabetic Eye Screening Service, Ilford, England
| | - Irene Stratton
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, England
| | | | - Samantha S Mann
- Guy's and St Thomas' Hospital NHS Trust, London, England
- South East London Diabetic Eye Screening Programme, London, England
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11
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Imanaga N, Terao N, Sonoda S, Sawaguchi S, Yamauchi Y, Sakamoto T, Koizumi H. Relationship Between Scleral Thickness and Choroidal Structure in Central Serous Chorioretinopathy. Invest Ophthalmol Vis Sci 2023; 64:16. [PMID: 36662534 PMCID: PMC9872835 DOI: 10.1167/iovs.64.1.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose Central serous chorioretinopathy (CSC) is a retinal disorder characterized by serous retinal detachment with or without pigment epithelial detachment in the posterior pole of the eye. We aimed to elucidate the relationship between scleral thickness and choroidal structure in CSC eyes. Methods This single-center retrospective study included 111 eyes of 111 CSC patients. Using swept-source optical coherence tomography, the horizontal cross-sectional images of the posterior choroid were converted to binary images by semiautomated software. The luminal and stromal areas of the choroid were measured, and the luminal/stromal (L/S) ratios of the whole choroid (WC), inner choroid, and outer choroid (OC) at 1500 µm, 3000 µm, and 7500 µm ranges centered on the fovea were calculated. Correlations of L/S ratio and age, spherical equivalent, axial length, subfoveal choroidal thickness (SCT), and scleral thickness were determined. Scleral thickness was measured vertically, 6 mm posterior to the scleral spur in four directions. Results SCT and mean scleral thickness were significantly positively correlated with the L/S ratio in all ranges of WC and OC. Multiple regression analysis found that SCT and mean scleral thickness were significantly correlated with the L/S ratio, and the strength of correlation of mean scleral thickness (WC: 0.386, P < 0.001; OC: 0.391, P < 0.001) was greater than that of SCT (WC: 0.368, P < 0.001; OC: 0.383, P < 0.001) in 7500 µm range. Conclusions Thick sclera appeared to play a role in an increase in the luminal component of the posterior choroid in CSC eyes.
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Affiliation(s)
- Naoya Imanaga
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Nobuhiro Terao
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shozo Sonoda
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shota Sawaguchi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yukihide Yamauchi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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12
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Ohkuma M, Maruyama T, Ishii T, Igarashi N, Azuma K, Inoue T, Obata R, Miyachi EI, Kaneda M. Effects of Progesterone and Other Gonadal Hormones on Glutamatergic Circuits in the Retina. J NIPPON MED SCH 2023; 90:333-345. [PMID: 37690823 DOI: 10.1272/jnms.jnms.2023_90-405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Gonadal hormones function in the retina; however, their targets have not yet been identified. Therefore, the present study examined the effects of progesterone and other gonadal hormones on glutamatergic circuits in the retina. METHODS Extracellular glutamate concentrations, which correspond to the amount of glutamate released, were examined using an enzyme-linked fluorescent assay system. The activity of glutamatergic synapses between bipolar cells and ganglion cells was investigated using a patch clamp technique. Changes in retinal thickness during pregnancy were assessed using optical coherence tomography (OCT) images. RESULTS Progesterone and pregnenolone sulfate increased extracellular glutamate concentrations, whereas estrogen and testosterone did not. Progesterone increased the activity of glutamatergic synapses between bipolar cells and ganglion cells. A temporal decrease in the thickness of the peripheral retina was observed in the 1st trimester. CONCLUSIONS Progesterone, but not estrogen or testosterone, activated glutamate release in the mouse retina. Increases in the concentration of progesterone during pregnancy did not induce any detectable change in retinal thickness.
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Affiliation(s)
| | - Takuma Maruyama
- Department of Physiology, Nippon Medical School
- Present address: Department of Physiology, Division of Neurophysiology, School of Medicine, Tokyo Women's Medical University
| | | | - Nozomi Igarashi
- Department of Ophthalmology, Faculty of Medicine, Tokyo University
| | - Keiko Azuma
- Department of Ophthalmology, Faculty of Medicine, Tokyo University
| | - Tatsuya Inoue
- Department of Ophthalmology, School of Medicine, Yokohama City University
| | - Ryo Obata
- Department of Ophthalmology, Faculty of Medicine, Tokyo University
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13
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Alizadeh Y, Moravvej Z, Soltani-Moghadam R, Dourandeesh M, Akbari M, Azaripour E, Medghalchi A, Sorouri ZZ, Motaghinia Z. Evaluation of Choroidal Thickness during Pregnancy and Postpartum: A Longitudinal Study. J Curr Ophthalmol 2022; 34:312-317. [PMID: 36644463 PMCID: PMC9832460 DOI: 10.4103/joco.joco_42_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/22/2022] [Accepted: 06/12/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To assess the longitudinal changes of choroidal thickness using enhanced depth imaging optical coherence tomography (EDI-OCT) during pregnancy and postpartum. Methods The study included 23 eyes of 23 healthy pregnant women and 23 eyes of 23 healthy nonpregnant women. Choroidal thickness was measured manually with EDI-OCT at seven locations: The fovea, 500, 1000, and 1500 μm temporal (T) from the fovea and 500, 1000, and 1500 μm nasal (N) from the fovea. Measurements were obtained at each pregnancy trimester and 6 weeks postpartum and in the follicular phase of the menstrual cycle for the control group. Results The mean subfoveal choroidal thickness was 410.2 ± 82.4 μm, 434.8 ± 79.6 μm, 433.5 ± 80.3 μm, and 395.0 ± 71.1 μm in the first, second, and third trimesters and 6 weeks postpartum, respectively. In all seven measured locations, statistically significant changes were noted during pregnancy and postpartum in the choroidal thickness (P < 0.001). Choroidal thickness increased from the first trimester to the second and third trimester, after which it decreased at postpartum. Choroidal thickness was greater in the pregnant group during pregnancy and postpartum compared to the control group (P < 0.001). Conclusions This study indicated significant change in choroidal thickness at seven locations measured with EDI-OCT throughout pregnancy and 6 weeks after delivery. We showed that 6 weeks after delivery, choroidal thickness remains significantly higher than nonpregnant subjects.
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Affiliation(s)
- Yousef Alizadeh
- Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Moravvej
- Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran,Department of Ophthalmology, Hakim Hospital, Neyshabour University of Medical Sciences, Neyshabour, Iran,Address for correspondence: Zahra Motaghinia, Department of Ophthalmology, School of Medicine, Arak University of Medical Sciences, Arak, Iran. E-mail:
| | - Reza Soltani-Moghadam
- Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Dourandeesh
- Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mitra Akbari
- Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ebrahim Azaripour
- Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Abdolreza Medghalchi
- Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ziba Zahiri Sorouri
- Department of Obstetrics and Gynecology, Reproductive Health Research Center, Alzahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Motaghinia
- Department of Ophthalmology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
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14
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Wiedemann J, Altay L, Neugebauer A, Krohne T, Cursiefen C. Visual complaints in pregnancy: (pre)eclampsia as a chameleon. GMS OPHTHALMOLOGY CASES 2022; 12:Doc21. [PMID: 36569356 PMCID: PMC9762176 DOI: 10.3205/oc000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective The visual system often is affected in patients with preeclampsia and even more in cases of eclampsia, a life-threatening pregnancy complication. Symptoms include blurred vision and deterioration of visual acuity. Pregnancy can also affect pre-existing conditions, such as diabetic retinopathy. In this case series, we describe three patients with the same underlying condition, i.e. (pre)eclampsia who experienced acute visual disturbance whereas the final diagnosis was different: disseminated intravascular coagulopathy (DIC), posterior reversible encephalopathy syndrome (PRES), and diabetic retinopathy. Methods and results All patients underwent a thorough slit lamp examination and ocular coherence tomography (OCT). All patients presented with acute impaired vision and subretinal fluid and-/or fibrin. Conclusions These cases highlight the importance of early involvement of ophthalmologists when pregnant women complain about visual disorders.
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Affiliation(s)
- Johanna Wiedemann
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Germany,*To whom correspondence should be addressed: Johanna Wiedemann, Department of Ophthalmology and Eye Hospital, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany, E-mail:
| | - Lebriz Altay
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Germany
| | - Antje Neugebauer
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Germany
| | - Tim Krohne
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Germany
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15
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Jürgens L, Yaici R, Schnitzler CM, Fleitmann AK, Roth M, Schröder K, Guthoff R. Retinal vascular occlusion in pregnancy: three case reports and a review of the literature. J Med Case Rep 2022; 16:167. [PMID: 35449024 PMCID: PMC9022314 DOI: 10.1186/s13256-022-03369-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 02/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Retinal arterial occlusive events in young patients are rare. However, because of physiological multifactorial adaptations during pregnancy, retinal vascular occlusive disease may occur spontaneously. In addition, a patent foramen ovale is a risk factor for an ischemic thromboembolic event. Since fluorescein angiography, a central tool in the evaluation of these occlusions, should be avoided during pregnancy, optical coherence tomography angiography, a novel technique, offers a good opportunity for visualizing vascular perfusion of retinal tissue. Case presentation Here we present a case series of three patients (Caucasian, nonsmoker) who visited our clinic owing to acute visual impairment and central scotoma. Using regular optical coherence tomography and optical coherence tomography angiography, retinal vascular occlusions were detected, thus initiating the evaluation of systemic risk factors. We report two patients (30 and 32 years old) who developed cilioretinal artery occlusion but whose etiology differed: one was of thromboembolic origin associated with patent foramen ovale, while the other was caused by hemodynamic blockade secondary to central retinal vein occlusion. In both cases, optical coherence tomography angiography revealed reperfusion of the cilioretinal artery occlusion. However, transient ischemia led to retinal atrophy after a few weeks. In the third patient (32 years old), 8 weeks after onset of scotoma, optical coherence tomography angiography revealed atrophy of the middle layers and impaired perfusion in the deep capillary plexus, and thus a paracentral acute middle maculopathy was diagnosed. All patients regained normal visual acuity and had otherwise uncomplicated pregnancies, and laboratory blood tests did not reveal any defects or alterations. Conclusions As shown here, optical coherence tomography angiography enables risk-free imaging of retinal vessel perfusion during pregnancy. Together with regular optical coherence tomography, it allows one to predict functional outcome according to the existing retinal occlusion-related atrophy.
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Affiliation(s)
- L Jürgens
- Department of Ophthalmology, University of Duesseldorf, Moorenstr. 5, D-40225, Düsseldorf, Germany
| | - R Yaici
- Department of Ophthalmology, University of Duesseldorf, Moorenstr. 5, D-40225, Düsseldorf, Germany
| | - C M Schnitzler
- Department of Ophthalmology, University of Duesseldorf, Moorenstr. 5, D-40225, Düsseldorf, Germany
| | - A K Fleitmann
- Department of Obstetrics and Gynaecology, University of Duesseldorf, Düsseldorf, Germany
| | - M Roth
- Department of Ophthalmology, University of Duesseldorf, Moorenstr. 5, D-40225, Düsseldorf, Germany
| | - K Schröder
- Department of Ophthalmology, University of Duesseldorf, Moorenstr. 5, D-40225, Düsseldorf, Germany
| | - R Guthoff
- Department of Ophthalmology, University of Duesseldorf, Moorenstr. 5, D-40225, Düsseldorf, Germany.
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16
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Wright PH, Khalid H, Keane PA. The utility of wide-field optical coherence tomography angiography in diagnosis and monitoring of proliferative diabetic retinopathy in pregnancy. Am J Ophthalmol Case Rep 2022; 25:101280. [PMID: 35112021 PMCID: PMC8789599 DOI: 10.1016/j.ajoc.2022.101280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/13/2021] [Accepted: 01/13/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose Observations Conclusions and importance
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Affiliation(s)
| | - Hagar Khalid
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Pearse A. Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Corresponding author. 162 City Road, Old Street, London, EC1V 2PD, UK.
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17
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Chandrasekaran PR, Madanagopalan VG, Narayanan R. Diabetic retinopathy in pregnancy - A review. Indian J Ophthalmol 2021; 69:3015-3025. [PMID: 34708737 PMCID: PMC8725079 DOI: 10.4103/ijo.ijo_1377_21] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Diabetes and gestational diabetes (GD) are areas of concern worldwide. GD can eventually lead to serious development of diabetic retinopathy (DR) during pregnancy or worsening of an already existing DR. GD confers future risk of diabetes, both in the mother and fetus, further complicating their lives. DR in pregnant women has been intriguing in terms of understanding the prevalence, assessing risk factors causing pathogenesis, and problems associated with treating them. Pregnancy itself is a risk factor for progression of DR. Physiological changes such as metabolic, vascular, immunologic, and hormonal changes that occur during pregnancy can cause development as well as worsening of DR. This can eventually lead to permanent visual loss if not addressed on time. Timing of laser, choice of treatment for diabetic macular edema with laser, intravitreal anti-vascular endothelial growth factor agents (VEGF), and intravitreal steroids pose a serious challenge in managing these patients without causing damage to the mother and fetus. This review article showcases the prevalence, risk factors, and pathogenesis, outlines the management of DR in pregnancy, and recommends guidelines based on the available evidence. PubMed and MEDLINE searches were performed pertaining to the prevalence of GD in India, DR in pregnancy, risk factors for progression of DR, role of vasoactive mediators in DR, role of angiopoietic factors in DR, hormonal influence of DR, role of growth factors in DR, use of fluorescein and indocyanine green angiography, retinal lasers, anti-VEGF agents, intravitreal steroids, anesthesia, and retinal surgery, all pertaining to pregnancy and guidelines and recommendations for managing DR in pregnancy.
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Affiliation(s)
| | - V G Madanagopalan
- Cataract and Vitreoretinal Services, JB Eye Hospital, Salem, Tamil Nadu, India
| | - Raja Narayanan
- Director-The Retina Institute and Suven Clinical Research Centre, Consultant Ophthalmologist, Vitreo Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
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18
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Belkin A, Chen T, DeOliveria AR, Johnson SM, Ramulu PY, Buys YM. A Practical Guide to the Pregnant and Breastfeeding Patient with Glaucoma. Ophthalmol Glaucoma 2021; 3:79-89. [PMID: 32672600 DOI: 10.1016/j.ogla.2019.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Avner Belkin
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Teresa Chen
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | | | | | - Pradeep Y Ramulu
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, Ontario, Canada.
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Lejoyeux R, Benillouche J, Ong J, Errera MH, Rossi EA, Singh SR, Dansingani KK, da Silva S, Sinha D, Sahel JA, Freund KB, Sadda SR, Lutty GA, Chhablani J. Choriocapillaris: Fundamentals and advancements. Prog Retin Eye Res 2021; 87:100997. [PMID: 34293477 DOI: 10.1016/j.preteyeres.2021.100997] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022]
Abstract
The choriocapillaris is the innermost structure of the choroid that directly nourishes the retinal pigment epithelium and photoreceptors. This article provides an overview of its hemovasculogenesis development to achieve its final architecture as a lobular vasculature, and also summarizes the current histological and molecular knowledge about choriocapillaris and its dysfunction. After describing the existing state-of-the-art tools to image the choriocapillaris, we report the findings in the choriocapillaris encountered in the most frequent retinochoroidal diseases including vascular diseases, inflammatory diseases, myopia, pachychoroid disease spectrum disorders, and glaucoma. The final section focuses on the development of imaging technology to optimize visualization of the choriocapillaris as well as current treatments of retinochoroidal disorders that specifically target the choriocapillaris. We conclude the article with pertinent unanswered questions and future directions in research for the choriocapillaris.
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Affiliation(s)
| | | | - Joshua Ong
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
| | - Sumit R Singh
- Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, CA, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Susana da Silva
- Department of Ophthalmology and Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Debasish Sinha
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Cell Biology and Center for Biologic Imaging, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Rothschild Foundation, 75019, Paris, France; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France; CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
| | - K Bailey Freund
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University of Medicine, New York, NY, USA; Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, 90033, USA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gerard A Lutty
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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20
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Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group. Eye (Lond) 2021; 34:1-51. [PMID: 32504038 DOI: 10.1038/s41433-020-0961-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The management of diabetic retinopathy (DR) has evolved considerably over the past decade, with the availability of new technologies (diagnostic and therapeutic). As such, the existing Royal College of Ophthalmologists DR Guidelines (2013) are outdated, and to the best of our knowledge are not under revision at present. Furthermore, there are no other UK guidelines covering all available treatments, and there seems to be significant variation around the UK in the management of diabetic macular oedema (DMO). This manuscript provides a summary of reviews the pathogenesis of DR and DMO, including role of vascular endothelial growth factor (VEGF) and non-VEGF cytokines, clinical grading/classification of DMO vis a vis current terminology (of centre-involving [CI-DMO], or non-centre involving [nCI-DMO], systemic risks and their management). The excellent UK DR Screening (DRS) service has continued to evolve and remains world-leading. However, challenges remain, as there are significant variations in equipment used, and reproducible standards of DMO screening nationally. The interphase between DRS and the hospital eye service can only be strengthened with further improvements. The role of modern technology including optical coherence tomography (OCT) and wide-field imaging, and working practices including virtual clinics and their potential in increasing clinic capacity and improving patient experiences and outcomes are discussed. Similarly, potential roles of home monitoring in diabetic eyes in the future are explored. The role of pharmacological (intravitreal injections [IVT] of anti-VEGFs and steroids) and laser therapies are summarised. Generally, IVT anti-VEGF are offered as first line pharmacologic therapy. As requirements of diabetic patients in particular patient groups may vary, including pregnant women, children, and persons with learning difficulties, it is important that DR management is personalised in such particular patient groups. First choice therapy needs to be individualised in these cases and may be intravitreal steroids rather than the standard choice of anti-VEGF agents. Some of these, but not all, are discussed in this document.
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Seo D, Lee T, Kim JY, Seong GJ, Choi W, Bae HW, Kim CY. Glaucoma Progression after Delivery in Patients with Open-Angle Glaucoma Who Discontinued Glaucoma Medication during Pregnancy. J Clin Med 2021; 10:jcm10102190. [PMID: 34069406 PMCID: PMC8159078 DOI: 10.3390/jcm10102190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 01/22/2023] Open
Abstract
In this retrospective study, clinical characteristics and glaucoma progression of open-angle glaucoma (OAG) patients who discontinued intraocular pressure (IOP)-lowering medication during pregnancy were investigated. Glaucoma progression was determined using either serial visual field tests or optic disc/retinal nerve fiber layer (RNFL) photographs. Age, number of previous pregnancies, diagnosis, average IOP, IOP fluctuation, visual field mean deviation, pattern standard deviation, and RNFL thickness were examined, and their association with glaucoma progression was determined using linear regression analysis. Among 67 eyes (37 patients), 19 eyes (28.4%) exhibited glaucoma progression 13.95 ± 2.42 months after delivery. The progression group showed significantly higher mean IOP than the nonprogression group in the first, second, and third trimesters (p = 0.02, 0.001, and 0.04, respectively). The average IOP in the second, and third trimesters and IOP fluctuation during the entire pregnancy were significantly associated with glaucoma progression according to a univariate analysis (p = 0.04, 0.031, and 0.026, respectively). In conclusion, IOP elevation during pregnancy is associated with glaucoma progression after delivery in patients who had discontinued medication during pregnancy. Therefore, close monitoring of glaucoma is necessary, particularly if patients discontinue medication during pregnancy, and appropriate intervention should be considered in case of increased IOP.
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Affiliation(s)
| | | | | | | | | | | | - Chan Yun Kim
- Correspondence: ; Tel.: +82-2-2228-3570; Fax: +82-2-312-0541
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Morya AK, Gogia S, Gupta A, Prakash S, Solanki K, Naidu AD. Motherhood: What every ophthalmologist needs to know. Indian J Ophthalmol 2021; 68:1526-1532. [PMID: 32709768 PMCID: PMC7640830 DOI: 10.4103/ijo.ijo_2033_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this review article is to summarize the available literature on physiologic and pathologic ocular changes during pregnancy and the effect of diseases in pregnancy. A literature search was conducted using PUBMED, MEDLINE, and Cochrane library in English. In addition, the cited references in the published articles were manually reviewed for the relevant results. Pregnancy encompasses a multitude of changes in all body systems, including the visual system of the female. The changes can be physiological, i.e., changes occurring in the lids and adnexa, cornea, conjunctiva, changes in tear film composition and intraocular pressure, retina, choroid, and visual field. Pathological changes in a pregnant woman's eye include changes related to preeclampsia and eclampsia, central serous chorioretinopathy, retinal artery or vein occlusions, and disseminated intravascular coagulation. Preexisting diseases like diabetic retinopathy, Graves' disease, idiopathic intracranial hypertension, various inflammatory conditions can undergo changes in their course during pregnancy. Ophthalmic medications can have an effect on both mother and the baby and hence should be used cautiously. In addition, intrauterine infections play a major role in causing inflammation in the eye of the baby. Hence, vaccination of the mother prior to pregnancy plays an important role in preventing intrauterine infections in the neonate. A regular eye examination in the perinatal period plays a vital role in recognizing ophthalmic pathologies which might require a prompt medical intervention. Pathological ocular diseases should be discriminated from physiologic changes to establish an individualized treatment or preventive plan. This approach to ocular benefits of treatment to the mother should always weigh against the potential harm to the fetus.
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Affiliation(s)
- Arvind K Morya
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Sonalika Gogia
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Arushi Gupta
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Sujeet Prakash
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Kanchan Solanki
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
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Shalaby HS, ElSebaay ME, Samy MM. Comparison Between Central Choroidal Thickness in Pregnant Diabetic Females and Pregnant Non-Diabetic Females. Clin Ophthalmol 2021; 15:105-111. [PMID: 33469256 PMCID: PMC7811481 DOI: 10.2147/opth.s289514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To compare choroidal thickness in pregnant women with and without diabetes mellitus (DM). Methods Sixty pregnant females (60 eyes) were enrolled in this cross-sectional controlled study. They were divided into two groups: Group A (30 patients; 30 eyes) were pregestational diabetic pregnant females, while Group B (30 patients; 30 eyes) were non-diabetic pregnant females. Exclusion criteria were high-risk pregnancy, diabetic retinopathy in Group A subjects, systemic or ophthalmological pathology, drug intake other than vitamin supplements and diabetic medications, and large errors of refraction. All patients underwent full ophthalmological examination and enhanced depth imaging optical coherence tomography (EDI-OCT) to measure the choroidal thickness in the nine zones of the Early Treatment Diabetic Retinopathy Study (ETDRS) map. Results Our results show that Group A eyes (of pregnant diabetic females) had a highly significant greater choroidal thickness than Group B eyes (of pregnant non-diabetic females) in all nine zones of the ETDRS map (p-value <0.01). Moreover, we found a positive linear correlation between the duration of DM and the degree of choroidal thickening. Conclusion Pregnant diabetic females have a thicker choroid than that of pregnant non-diabetic females.
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Affiliation(s)
- Hisham Samy Shalaby
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Mohamed Mahmoud Samy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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24
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Pickering TD, Radhakrishnan S. Glaucoma and Pregnancy. CURRENT OPHTHALMOLOGY REPORTS 2020. [DOI: 10.1007/s40135-020-00239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brooks CC, Brodie F, Brodie R, Buck M, Postel EA. Management of a rhegmatogenous retinal detachment in a pregnant patient. Am J Ophthalmol Case Rep 2020; 18:100708. [PMID: 32368690 PMCID: PMC7184526 DOI: 10.1016/j.ajoc.2020.100708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/01/2020] [Accepted: 04/09/2020] [Indexed: 11/11/2022] Open
Abstract
Purpose To describe the management of a rhegmatogenous retinal detachment (RRD) in a pregnant patient. Observations A 30-year-old, 26-week pregnant female presented with curtain vision loss in the left eye. Exam findings were significant in the left eye for an inferior fovea-sparing RRD. Care was coordinated and discussed with anesthesia and OB/GYN. The patient underwent surgery with monitored anesthesia care and a 41 scleral buckle, cryotherapy and C3F8 gas. The retina remained attached at 4 months post-operatively. A healthy girl was delivered via spontaneous vaginal delivery at 39 weeks. Conclusion Safe and successful treatment of RRD in pregnant patients can be achieved with careful coordination between ophthalmology, anesthesia, and obstetrics. An understanding of pregnancy specific considerations is important in order to optimize patient outcomes.
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Affiliation(s)
| | - Frank Brodie
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Rachel Brodie
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Matthew Buck
- Department of Anesthesiology, Duke University, Durham, NC, USA
| | - Eric A Postel
- Department of Ophthalmology, Duke University, Durham, NC, USA
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Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Retinal Vein Occlusions Preferred Practice Pattern®. Ophthalmology 2020; 127:P288-P320. [DOI: 10.1016/j.ophtha.2019.09.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
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Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern®. Ophthalmology 2020; 127:P259-P287. [DOI: 10.1016/j.ophtha.2019.09.028] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 11/30/2022] Open
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van Rijssen TJ, van Dijk EHC, Yzer S, Ohno-Matsui K, Keunen JEE, Schlingemann RO, Sivaprasad S, Querques G, Downes SM, Fauser S, Hoyng CB, Piccolino FC, Chhablani JK, Lai TYY, Lotery AJ, Larsen M, Holz FG, Freund KB, Yannuzzi LA, Boon CJF. Central serous chorioretinopathy: Towards an evidence-based treatment guideline. Prog Retin Eye Res 2019; 73:100770. [PMID: 31319157 DOI: 10.1016/j.preteyeres.2019.07.003] [Citation(s) in RCA: 274] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 12/17/2022]
Abstract
Central serous chorioretinopathy (CSC) is a common cause of central vision loss, primarily affecting men 20-60 years of age. To date, no consensus has been reached regarding the classification of CSC, and a wide variety of interventions have been proposed, reflecting the controversy associated with treating this disease. The recent publication of appropriately powered randomised controlled trials such as the PLACE trial, as well as large retrospective, non-randomised treatment studies regarding the treatment of CSC suggest the feasibility of a more evidence-based approach when considering treatment options. The aim of this review is to provide a comprehensive overview of the current rationale and evidence with respect to the variety of interventions available for treating CSC, including pharmacology, laser treatment, and photodynamic therapy. In addition, we describe the complexity of CSC, the challenges associated with treating CSC, and currently ongoing studies. Many treatment strategies such as photodynamic therapy using verteporfin, oral mineralocorticoid antagonists, and micropulse laser treatment have been reported as being effective. Currently, however, the available evidence suggests that half-dose (or half-fluence) photodynamic therapy should be the treatment of choice in chronic CSC, whereas observation may be the preferred approach in acute CSC. Nevertheless, exceptions can be considered based upon patient-specific characteristics.
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Affiliation(s)
- Thomas J van Rijssen
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Suzanne Yzer
- Department of Ophthalmology, Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Graduate School, Tokyo, Japan
| | - Jan E E Keunen
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre 162, London, United Kingdom
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, West Wing, Oxford, United Kingdom
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Jay K Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, India
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong; 2010 Retina & Macula Centre, Tsim Sha Tsui, Kowloon, Hong Kong
| | - Andrew J Lotery
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands.
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Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Diabetic Retinopathy Preferred Practice Pattern®. Ophthalmology 2019; 127:P66-P145. [PMID: 31757498 DOI: 10.1016/j.ophtha.2019.09.025] [Citation(s) in RCA: 314] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
| | | | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR
| | - Amani Fawzi
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - G Atma Vemulakonda
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA
| | - Gui-Shuang Ying
- Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Abstract
INTRODUCTION Pregnancy is a risk factor for progression of diabetic retinopathy (DR). Despite the common opinion about the regression of DR after childbirth, it is possible for the disease to progress aggressively, which can cause loss of visual functions when treated untimely. PURPOSE To present clinical cases with different course of development of DR in pregnant women with type 1 diabetes mellitus (DM1). MATERIAL AND METHODS Five pregnant women with DM1 lasting more than 8 years were examined. Glycemic level of all patients was higher than normal (glycated hemoglobin (HbA1c) of more than 6.1%). Ophthalmologic examination was carried out including fundus photography, optical coherence tomography (OCT) of the macular area, Angio-OCT. RESULTS The most significant factors in the progression of DR in pregnant women are DR1 compensation, severity and stabilization of DR during the preconception period, presence of a concomitant pathology. Timely detection of signs of progression of DR and therapeutic measures taken during pregnancy, in particular laser coagulation, were shown to stabilize the course of the disease and prevent loss of vision in pregnant women with DM1. CONCLUSION Clinical course of DR in pregnancy can vary between absence of manifestation, stabilization, and progression. Progression of DR during pregnancy is determined by a number of factors including compensation of DM during the preconception period and throughout pregnancy, severity and stabilization of retinopathy during the preconception period, and presence of a concomitant pathology. Timely detection of the signs of DR progression and its treatment, in particular laser coagulation of the retina, can help stabilize the course of the disease during pregnancy. The course of DR may be aggressive in some pregnant women involving progression in the postpartum period, which warrants active monitoring of patients with retinopathy after childbirth.
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Affiliation(s)
- N V Pomytkina
- Khabarovsk branch of S. Fyodorov Eye Microsurgery Federal State Institution, 211 Tikhookeanskaia St., Khabarovsk, Russian Federation, 680033
| | - E L Sorokin
- Khabarovsk branch of S. Fyodorov Eye Microsurgery Federal State Institution, 211 Tikhookeanskaia St., Khabarovsk, Russian Federation, 680033; Far-Eastern State Medical University, 35 Muravyov-Amursky St., Khabarovsk, Russian Federation, 680000
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Adekomi AD, Moodley J, Naicker T. Neuropathological complications associated with hypertensive disorders of pregnancy. Hypertens Pregnancy 2019; 38:171-175. [PMID: 31213115 DOI: 10.1080/10641955.2019.1626417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: Hypertensive disorders in pregnancy particularly severe preeclampsia and eclampsia result in significant maternal and neonatal morbidity and mortality. Many of these misfunctions can aggravate some of the neuropathological complications of hypertensive disorders during pregnancy. Method: In this review article, we described some of the neuropathological complications associated with hypertensive disorders of pregnancy. Results and conclusion: It is explained how the possible mechanism of neuropathological events triggers some of the complications associated with hypertensive disorders of pregnancy. Conclusion: A strong plea is made for the early detection of high blood pressure, its immediate control with rapid acting anti-hypertensive agents if necessary and timeous delivery of fetus as the exact pathogenesis of preeclampsia remains unknown.
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Affiliation(s)
- Adedayo Damilare Adekomi
- a Optics and Imaging Centre, School of Laboratory Medicine and Medical Sciences, College of Health Sciences , University of KwaZulu-Natal , Durban , South Africa.,b Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences , Osun State University , Osogbo , Nigeria
| | - Jagidesa Moodley
- c Women's Health and HIV Research Group, Department of Obstetrics and Gynecology, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa
| | - Thajasvarie Naicker
- a Optics and Imaging Centre, School of Laboratory Medicine and Medical Sciences, College of Health Sciences , University of KwaZulu-Natal , Durban , South Africa
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Kalogeropoulos D, Sung VC, Paschopoulos M, Moschos MM, Panidis P, Kalogeropoulos C. The physiologic and pathologic effects of pregnancy on the human visual system. J OBSTET GYNAECOL 2019; 39:1037-1048. [PMID: 31190583 DOI: 10.1080/01443615.2019.1584891] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pregnancy is a normal state of physiological stress that induces significant changes in the human body, some of which can potentially affect the visual system. The pregnant state may exacerbate pre-existing ocular disorders (i.e. diabetic retinopathy or central serous retinopathy). Moreover, other systemic conditions related to pregnancy can induce ophthalmic disorders affecting the retina and the choroid, some of which are of acute nature. Increasing awareness and improving collaboration between ophthalmologists, obstetricians and internists can play a pivotal role in the management of complex conditions during pregnancy. Special attention should be given while prescribing medications or deciding about other diagnostic or therapeutic techniques. The purpose of this review is to summarise the physiologic and pathologic effects of pregnancy in the eyes, highlighting the most acute clinical entities that may be threatening for the vision or even the life of the mother and her baby.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Birmingham and Midland Eye Centre , Birmingham , United Kingdom.,Department of Ophthalmology, Faculty of Medicine School of Health Sciences, University of Ioannina , Ioannina , Greece
| | - Velota Ct Sung
- Birmingham and Midland Eye Centre , Birmingham , United Kingdom
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, Faculty of Medicine School of Health Sciences, University of Ioannina , Ioannina , Greece
| | - Marilita M Moschos
- First Department of Ophthalmology, General Hospital of Athens G. Gennimatas Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | | | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine School of Health Sciences, University of Ioannina , Ioannina , Greece
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Doğanlar ZB, Güçlü H, Öztopuz Ö, Türkön H, Dogan A, Uzun M, Doğanlar O. The Role of Melatonin in Oxidative Stress, DNA Damage, Apoptosis and Angiogenesis in Fetal Eye under Preeclampsia and Melatonin Deficiency Stress. Curr Eye Res 2019; 44:1157-1169. [PMID: 31090463 DOI: 10.1080/02713683.2019.1619778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Aim: The aim of this study was to investigate the possible mechanisms of ocular damage induced by pinealectomy (PNX) and preeclampsia (PE), and to determine the cellular and molecular effects of melatonin treatment on oxidative stress, DNA damage, molecular chaperone responses, induction of apoptosis and angiogenesis in the fetal eye of both PNX and PNX+PE animals. Material and Methods: We analysed therapeutic potential of melatonin on fetal eye damage in PNX and PNX+PE animals using Malondialdehyde (MDA), Random Amplified Polymorphic DNA (RAPD), qRT-PCR and Western blot assays. Results: Our study presents three preliminary findings: (a) in fetal eye tissues, PNX and PNX+PE significantly induce oxidative damage to both DNA and protein contents, leading to a dramatic increase in caspase-dependent apoptotic signalling in both mitochondrial and death receptor pathways; (b) the same conditions trigger hypoxia biomarkers in addition to significant overexpression of HIF1-α, HIF1-β, MMP9 and VEGF genes in the fetal eye; (c) finally, melatonin regulates not only the expression of genes encoding antioxidant enzymes and increase in DNA damage as well as lipid peroxidation but also limits programmed cell death processes in the fetal eye of PNX and PNX+PE animals . Furthermore, melatonin can relatively modulate genes in the HIF1 family, TNF-α and VEGF, thus acting as a direct anti-angiogenic molecule. In conclusion, both PNX and PNX+PE induce ocular damage at both cellular and molecular levels in fetal eye tissue of rats. Conclusion: Our results clearly indicate the potential of melatonin as a preventative therapeutic intervention for fetal ocular damage triggered by both PNX and PNX+PE.
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Affiliation(s)
- Zeynep Banu Doğanlar
- Department of Medical Biology, Faculty of Medicine, Trakya University , Edirne , Turkey
| | - Hande Güçlü
- Department of Ophthalmology, Faculty of Medicine, Trakya University , Edirne , Turkey
| | - Özlem Öztopuz
- Department of Biophysics, Faculty of Medicine, Çanakkale Onsekiz Mart University , Çanakkale , Turkey
| | - Hakan Türkön
- Department of Biochemistry, Faculty of Medicine, Çanakkale Onsekiz Mart University , Çanakkale , Turkey
| | - Ayten Dogan
- Department of Medical Biology, Faculty of Medicine, Trakya University , Edirne , Turkey
| | - Metehan Uzun
- Department of Physiology, Faculty of Medicine, Çanakkale Onsekiz Mart University , Çanakkale , Turkey
| | - Oguzhan Doğanlar
- Department of Medical Biology, Faculty of Medicine, Trakya University , Edirne , Turkey
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Serous retinal detachment in preeclampsia and malignant hypertension. Eye (Lond) 2019; 33:1707-1714. [PMID: 31089238 DOI: 10.1038/s41433-019-0461-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/19/2019] [Accepted: 03/12/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To compare and evaluate the characteristics of hypertensive choroidopathy with serous retinal detachment in preeclampsia and malignant hypertension (HTN) and explore choroidal ischemia as a pathogenesis using multimodal imaging. METHODS A retrospective multicenter case series. Medical charts were reviewed. Clinical characteristics and multimodal imaging, including optical coherence tomography (OCT) and OCT angiography (OCTA), were evaluated. RESULTS Fifty-three eyes of 29 preeclampsia patients and 45 eyes of 24 HTN patients were included. There were no differences in age, follow-up duration, baseline visual acuity, central macular thickness (CMT), or subfoveal choroidal thickness (CT) between the two groups. Blood pressure parameters, including systolic blood pressure, diastolic blood pressure, and pulse rate, were significantly higher in the HTN group. After serous retinal detachment resolved, both CMT (p < 0.001) and CT (p = 0.003) decreased more in the preeclampsia group. Hypertensive retinopathy features, including hemorrhage, exudates, cotton-wool spots, and optic disc edema, were predominantly found in the HTN group (p = 0.001). Final visual acuity was better in the preeclampsia group than in the HTN group (p = 0.048). Poor visual prognostic factors included the presence of retinopathy features (p = 0.005) and retinal detachment in the macula (p = 0.017). CONCLUSION Choroidal circulation may be affected earlier than retinal circulation by elevated blood pressure, presumably because of anatomical differences and autoregulatory mechanisms in the retinal vasculature. Serous retinal detachment with hypertensive choroidopathy presented with choroidal thickening that decreased after resolution, but the residual flow defects observed in the choriocapillaris on OCTA confirmed the long-hypothesized notion that ischemia is a mechanism underlying hypertensive choroidopathy.
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Zurawska-Klis M, Cypryk K. The Impact of Pregnancy and Parity on Type 1 Diabetes Complications. Curr Diabetes Rev 2019; 15:429-434. [PMID: 30648512 DOI: 10.2174/1573399815666190115143538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/11/2018] [Accepted: 01/08/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The potential influence of pregnancy and parity on the risk of chronic diabetic complications is a matter of great concern and constant discussion. This aspect seems relevant and should be the subject of thorough discussion with the woman planning childbirth. INTRODUCTION Current data concerning the impact of pregnancy and parity covers primarily retinopathy and nephropathy, while the aspects of neuropathy and macrovascular complications are unsatisfactorily documented. Majority of studies focus on single complication only, while the number of papers assessing this problem in a complex setting is limited. The available body of evidence concerns mainly the short-term impact of pregnancy on diabetic chronic complications while the data concerning the longer perspective are scarce. Moreover, the results found in the available literature are conflicting. The aim of the study was to summarize all available data concerning the longer impact of parity on the chronic complications in the women with type 1 diabetes. METHODS PubMed database has been searched between October 2013 and September 2018 and all relevant papers were selected. This review summarizes data on the impact of pregnancy and parity on chronic complications in type 1 diabetic women. RESULTS Current data assessing this matter in a complex way are limited, and the available results are controversial. It seems however that pregnancy itself may rather influence pre-existing diabetic complication than affect risk of its development. Additionally, evidence suggests that any deleterious changes appearing during pregnancy are transient and tend to remit after delivery. CONCLUSION It seems that neither pregnancy nor parity affects the risk of diabetic chronic complications in the longer perspective.
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Affiliation(s)
- Monika Zurawska-Klis
- Department of Internal Diseases and Diabetology, Medical University of Lodz, Pomorska Str. 251, 92-213 Lodz, Poland
| | - Katarzyna Cypryk
- Department of Internal Diseases and Diabetology, Medical University of Lodz, Pomorska Str. 251, 92-213 Lodz, Poland
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Corneal Endothelial Cell Density and Morphology in Different Trimesters of Pregnancy. Eye Contact Lens 2018; 44 Suppl 1:S125-S130. [DOI: 10.1097/icl.0000000000000354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nkiru ZN, Obiekwe O, Lilian O, Daniel CN, Uchenna IN, Rich U. Visual acuity and refractive changes among pregnant women in Enugu, Southeast Nigeria. J Family Med Prim Care 2018; 7:1037-1041. [PMID: 30598953 PMCID: PMC6259510 DOI: 10.4103/jfmpc.jfmpc_335_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Pregnancy has been associated with changes in the eye which could be physiological, pathological, or exacerbation of pre-existing ocular conditions. Visual acuity (VA) and refractive error (RE) changes are part of the physiological changes that may occur during pregnancy. OBJECTIVE The objective of the present study was to investigate changes in VA and RE across two different trimesters and six weeks postpartum among pregnant women in Enugu, southeast, Nigeria. MATERIALS AND METHODS A longitudinal study was adopted and pregnant women in their second trimester attending antenatal clinic at University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu were consecutively recruited. A questionnaire was used to obtain information on their sociodemographic and clinical characteristics. Visual acuity was measured and refractive error monitored in second and third trimesters and 6 weeks after delivery. RESULTS The mean age of women was 30.81 (±5.49) years and a majority of them were civil servants. There was a worsening of VA for distance in more women in the third trimesters compared to the second trimester. There was no significant change in VA for near throughout the study period. There was an increased myopic shift in more pregnant women during the third trimester (40; 40.0%) compared to second trimester (36; 36.0%). The most common refractive error found among the women was simple myopia. These changes resolved six weeks postpartum. CONCLUSION Pregnancy worsened VA for distance and the most common RE in pregnant women was simple myopia. However, these changes resolved during the postpartum period.
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Affiliation(s)
- Z. Nwachukwu Nkiru
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Okoye Obiekwe
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Okwesili Lilian
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - C. Nwachukwu Daniel
- Department of Physiology, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - I. Nwagha Uchenna
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Umeh Rich
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Makwana T, Takkar B, Venkatesh P, Sharma JB, Gupta Y, Chawla R, Vohra R, Kriplani A, Tandon N. Prevalence, progression, and outcomes of diabetic retinopathy during pregnancy in Indian scenario. Indian J Ophthalmol 2018; 66:541-546. [PMID: 29582816 PMCID: PMC5892058 DOI: 10.4103/ijo.ijo_1062_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose The objective of this study is to evaluate pattern of diabetic retinopathy (DR) during pregnancy in females with pregestational diabetes mellitus (DM). Methods This is an ambispective observational cohort study conducted at an Indian tertiary care centre. A total of 50 pregnant females with pregestational DM were included while those with gestational DM were excluded from the study. Ocular examination (inclusive of fundus photography) was conducted and systemic parameters (inclusive of Glycated hemoglobin) were assessed during each of the 3 trimesters and 3 months postpartum. The prevalence and progression of DR during pregnancy in the study cohort were the main outcome measures. Results Three of the 50 patients had type 1 DM while 47 had type II DM. All the patients with type I DM were insulin dependent while 19 patients with type II DM were insulin dependent. Overall prevalence of DR was 8% (4/50); 2 cases had nonproliferative DR (NPDR), and 2 had proliferative DR (PDR). During the study period, worsening was seen in both the patients with PDR and one required vitrectomy. Mean visual acuity in patients with PDR decreased from 0.77 logMAR units at presentation to 1.23 logMAR at final follow-up. There was no change in the mean visual acuity of patients with NPDR. None of the patients with NPDR converted to PDR. There was no new onset DR in the patients without DR at presentation. Assessment of risk factors for DR revealed significantly higher duration of DM (14 ± 6.32 years vs. 3.43 ± 1.43 years, P = 0.0008). The median age was also higher in the DR patients (31 years vs. 29 years, P = 0.32). Conclusion No new onset cases were seen during the course of pregnancy and no conversion from NPDR to PDR was seen; however, a worsening of the two PDR cases was observed. No cases of DR were seen in noninsulin-dependent DM. None of the four participants with DR showed a spontaneous resolution of DR postpartum. Patients with PDR and long-standing DM require careful observation during pregnancy. A registry of diabetic mothers should be set up for development of guidelines for managing such cases.
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Affiliation(s)
- Tarjani Makwana
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Brijesh Takkar
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Yashdeep Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajpal Vohra
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
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Olk RJ, Halperin LS, Soubrane G, Coscas G. Fluorescein Angiography - Is it Safe to use in a Pregnant Patient? Eur J Ophthalmol 2018; 1:103-6. [PMID: 1821200 DOI: 10.1177/112067219100100209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We sent questionnaires to 424 retina specialists in order to compile information on the use of fluorescein angiography in pregnant women. Four-hundred and three specialists responded. Of these, 313 (78%) had never performed fluorescein angiography on a pregnant woman. Ninety specialists (22%) had performed at least one fluorescein angiogram on a pregnant woman; detailed information was obtained on 105 patients. Authors of previous reports that included fluorescein angiography during pregnancy provided information on an additional 11 patients. Substantiated side effects were nausea and/or vomiting in seven patients. Anomalies at birth, an undescended testicle and syndactyly, were reported in two children. There was one stillbirth with pathologic findings classic for toxemia and one fetal death not related in time to fluorescein angiography. One therapeutic abortion was performed for complications in toxemia. One spontaneous abortion occurred 3 days after fluorescein angiography in a patient who was four weeks pregnant. Eight children born to toxemic mothers had low birth weights. Based on our data, we conclude that fluorescein angiography does not offer a high rate of birth anomalies or complications during pregnancy.
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Affiliation(s)
- R J Olk
- Department of Ophthalmology, Washington University School of Medicine, St. Louis, Missouri
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Naderan M. Ocular changes during pregnancy. J Curr Ophthalmol 2018; 30:202-210. [PMID: 30197948 PMCID: PMC6127369 DOI: 10.1016/j.joco.2017.11.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 10/20/2017] [Accepted: 11/29/2017] [Indexed: 02/06/2023] Open
Abstract
Purpose To summarize available literature on physiologic and pathologic ocular changes during pregnancy. Methods Narrative review of literature. Results Ocular changes occur commonly during pregnancy. Although most of these are benign physiologic responses to the metabolic, hormonal, and immunologic modifications to adopt the gestational product, there is some serious pathology that may develop, exacerbate, or even resolve over the course of pregnancy which requires prompt diagnosis and management. The pathological eye conditions can be classified into preexisting pathologies and emerging ocular diseases. Regardless of the different mechanisms by which these ocular changes occur, the key point is the establishment of an effective perinatal screening program to monitor the new development or successive progression of these ocular abnormalities. Irrespective of the visual health status of the pregnant women, regular perinatal eye examination should be scheduled in order to assure continuous surveillance of healthy eyes. Treatment of pathologic ocular conditions or functionally disturbing benign changes relies on an appropriate patient selection. Conclusions Discriminating pathological eye disease from physiologic ocular changes is important in order to establish an individualized treatment or preventive plan and constitutes the mainstay of obstetric ophthalmology. This individualized approach should always weigh the ocular benefits of treatment to the mother against the potential harms to the fetus.
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Affiliation(s)
- Mohammad Naderan
- School of Medicine, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, Iran. Fax: +98 21 88023944.
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European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition - Chapter 3: Treatment principles and options Supported by the EGS Foundation: Part 1: Foreword; Introduction; Glossary; Chapter 3 Treatment principles and options. Br J Ophthalmol 2017; 101:130-195. [PMID: 28559477 PMCID: PMC5583689 DOI: 10.1136/bjophthalmol-2016-egsguideline.003] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Zhang J, Wang H, Yu Q, Tong Q, Lu Q. Enhanced Depth Imaging Optical Coherence Tomography: A New Way Measuring Choroidal Thickness in Pregnant Women. J Ophthalmol 2017; 2017:8296574. [PMID: 28630765 PMCID: PMC5463124 DOI: 10.1155/2017/8296574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/18/2017] [Indexed: 12/28/2022] Open
Abstract
The body changes markedly during pregnancy; each system behaves differently from a nonpregnant state. As the eyes are the only windows to see directly what is going on in the internal environment, more and more researches have been done to explain the association between ocular changes and the physiological and pathological changes during pregnancy. The choroid is one of the critical parts of the eye, providing nutrition. And abnormal choroid may result in ocular dysfunction and visual problems. As the optical coherence tomography develops, a rapid, direct, noninvasive, and nontoxic way is available to obtain the choroid situation of pregnant women, which may explain the mechanism of pregnancy-related eye diseases. This review would summarize relevant original articles published from January 1, 2008 to December 1, 2016 to assess the changes of choroidal thickness (CT) with enhanced depth imaging optical coherence tomography (EDI-OCT) during pregnancy. And the relationship between choroidal thickness changes and pregnancy remains uncertain. To our knowledge, this is the first review of EDI-OCT in assessing the choroidal thickness of the pregnant women.
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Affiliation(s)
- Jun Zhang
- Medical School of Ningbo University, 818 Fenghua Road, Ningbo, Zhejiang, China
- Department of Ophthalmology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, 251 Baizhang East Road, Ningbo, Zhejiang, China
| | - Huiyun Wang
- Department of Ophthalmology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, 251 Baizhang East Road, Ningbo, Zhejiang, China
| | - Qiubo Yu
- Department of Obstetrics, Yinzhou Hospital Affiliated to Medical School of Ningbo University, 251 Baizhang East Road, Ningbo, Zhejiang, China
| | - Qihu Tong
- Department of Ophthalmology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, 251 Baizhang East Road, Ningbo, Zhejiang, China
| | - Qinkang Lu
- Department of Ophthalmology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, 251 Baizhang East Road, Ningbo, Zhejiang, China
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Drake SC, Vajaranant TS. Evidence-Based Approaches to Glaucoma Management During Pregnancy and Lactation. CURRENT OPHTHALMOLOGY REPORTS 2016; 4:198-205. [PMID: 33384894 PMCID: PMC7773175 DOI: 10.1007/s40135-016-0112-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
With increasing maternal age in this decade, there is a parallel rise in the number of pregnant and lactating women affected by glaucoma worldwide. Understanding the diagnosis and management of glaucoma during pregnancy and lactation is essential to preventing blindness from glaucoma in this vulnerable population. This report provides a review of the current literature and offers effective strategies that will overcome the challenges in managing glaucoma during pregnancy and lactation. Practically, glaucoma management during pregnancy and lactation presents a unique challenge for the physician, as the benefit of any treatment must be weighed against the potential risks to the fetus. Prior to initiating or continuing treatment, the physician should be familiar with the various treatment options to manage intraocular pressure during pregnancy and lactation, including the safety of various anti-glaucoma medications as supported by the existing literature and based on the food and drug administration guidelines. A collaborative team effort between the ophthalmologist, obstetrician, and neonatologist in high-risk pregnancies is recommended to optimize care for the mother and fetus.
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Affiliation(s)
| | - Thasarat S. Vajaranant
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W Taylor St, Chicago, IL, USA
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Lemaître S, Lévy-Gabriel C, Desjardins L, Plancher C, Asselain B, Vincent-Salomon A, Lumbroso-Le Rouic L, Dendale R, Rouzier R, Delacroix S, Cassoux N. Choroidal melanoma and pregnancy. Acta Ophthalmol 2016; 94:e652-e660. [PMID: 27009598 DOI: 10.1111/aos.12984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 12/09/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Choroidal melanoma is a rare tumour in adults. The mean age at diagnosis is 60, but the tumour can affect women of childbearing age. A negative effect of pregnancy on patients' survival has not been formally excluded to date. The aim of the present study is to evaluate the effect of pregnancy on the prognosis of choroidal melanoma. METHODS We conducted a single-centre retrospective study at the Institut Curie on the population of women of childbearing age who were diagnosed with choroidal melanoma between June 1980 and October 2013. We took a particular interest in the prognosis of those who were pregnant at the time of diagnosis and in the prognosis of those who chose to get pregnant after the treatment. RESULTS We found 27 pregnant patients at the time of diagnosis and 13 patients who became pregnant after the treatment. There was no difference in the survival between these two groups of patients and the group of other women of childbearing age diagnosed with choroidal melanoma (p = 0.52). There was also no difference in metastasis-free survival (p = 0.91). Most women were able to carry their pregnancies to term (67% had a term pregnancy, and only 7% had an abortion). For women who were pregnant when they were diagnosed with choroidal melanoma, a conservative treatment was chosen in 85% of cases, and proton beam therapy was the most widely used treatment. CONCLUSIONS Survival in women of childbearing age does not appear to be influenced by pregnancy. We show that proton beam therapy can be used to treat women who are pregnant at the time of choroidal melanoma diagnosis.
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Affiliation(s)
| | | | | | | | | | | | | | - Rémi Dendale
- Protontherapy Center (ICPO); Institut Curie; Paris France
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Parihar JKS, Kaushik J, Jain VK, Naredi N, Raina S. The effect of assisted reproductive technology on ocular assessments. Clin Exp Optom 2016; 99:575-579. [PMID: 27306565 DOI: 10.1111/cxo.12389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 02/03/2016] [Accepted: 02/10/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim was to study the various ocular assessments in women undergoing assisted reproductive techniques (ART). METHODS A total of 117 women with infertility were enrolled for study and the ART protocol was followed. The outcome measures were intraocular pressure (IOP), central corneal thickness, corneal endothelial cell counts, Schirmer I test done at baseline (V0), post-oral contraceptive (V1), post-GnRH agonist induction phase (V2), post-conception (V3), third trimester of pregnancy (V4) and three months post-partum (V5). Schirmer I test (without topical anaesthesia) less than 10 mm in at least one eye was considered a criterion for dry eye. RESULTS Out of 117 women enrolled for in vitro fertilisation (IVF), only 48 patients conceived. Sixteen women had abortions and remaining 32 women, who had childbirth were followed until three months post-partum. Baseline mean IOP showed a slight decrement and corneal pachymetry and corneal endothelial cell counts showed slight increment from phases V1 to V4 of ART but statistically they were not significant (p > 0.05). At three months post-partum (V5) mean IOP, corneal pachymetry, corneal endothelial cell counts become closer to baseline in both eyes. The number of patients with at least one eye with dryness (Schirmer I less than 10 mm) significantly increased at the third trimester (p = 0.02) and three months post-partum (p = 0.035), whereas in the rest of the phases, it was comparable to baseline (p > 0.05). CONCLUSION The ocular physiological changes (IOP, corneal pachymetry and corneal endothelial cell counts) seen in various phases of ART were non-specific. The ART appears to reduce tear secretions as measured by Schirmer I; however, further research would be required to determine the impact of ART on the tear film and whether ART is associated with symptoms and signs of dry eye.
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Affiliation(s)
| | - Jaya Kaushik
- Department of Ophthalmology, Command Hospital (WC), Chandimandir Cantonment, India
| | - Vaibhav Kumar Jain
- Department of Ophthalmology, Uttar Pradesh Rural Institute of Medical Sciences and Research, Etawah, India
| | - Nikita Naredi
- Department of Obstetrics & Gynecology & Assisted Reproductive Treatment Centre, Command Hospital (SC), Pune, India
| | - Sapna Raina
- Department of Ophthalmology, Air Force Central Medical Establishment, New Delhi, India
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Rajavi Z, Safi S, Javadi MA, Azarmina M, Moradian S, Entezari M, Nourinia R, Ahmadieh H, Shirvani A, Shahraz S, Ramezani A, Dehghan MH, Shahsavari M, Soheilian M, Nikkhah H, Ziaei H, Behboudi H, Farrahi F, Falavarjani KG, Parvaresh MM, Fesharaki H, Abrishami M, Shoeibi N, Rahimi M, Javadzadeh A, Karkhaneh R, Riazi-Esfahani M, Manaviat MR, Maleki A, Kheiri B, Golbafian F. Diabetic Retinopathy Clinical Practice Guidelines: Customized for Iranian Population. J Ophthalmic Vis Res 2016; 11:394-414. [PMID: 27994809 PMCID: PMC5139552 DOI: 10.4103/2008-322x.194131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/24/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To customize clinical practice guidelines (CPGs) for management of diabetic retinopathy (DR) in the Iranian population. METHODS Three DR CPGs (The Royal College of Ophthalmologists 2013, American Academy of Ophthalmology [Preferred Practice Pattern 2012], and Australian Diabetes Society 2008) were selected from the literature using the AGREE tool. Clinical questions were designed and summarized into four tables by the customization team. The components of the clinical questions along with pertinent recommendations extracted from the above-mentioned CPGs; details of the supporting articles and their levels of evidence; clinical recommendations considering clinical benefits, cost and side effects; and revised recommendations based on customization capability (applicability, acceptability, external validity) were recorded in 4 tables, respectively. Customized recommendations were sent to the faculty members of all universities across the country to score the recommendations from 1 to 9. RESULTS Agreed recommendations were accepted as the final recommendations while the non-agreed ones were approved after revision. Eventually, 29 customized recommendations under three major categories consisting of screening, diagnosis and treatment of DR were developed along with their sources and levels of evidence. CONCLUSION This customized CPGs for management of DR can be used to standardize the referral pathway, diagnosis and treatment of patients with diabetic retinopathy.
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Affiliation(s)
- Zhale Rajavi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Azarmina
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Moradian
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Entezari
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Nourinia
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Standardization and CPG Development Office, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Alireza Ramezani
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Dehghan
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Shahsavari
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Soheilian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homayoun Nikkhah
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Ziaei
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Behboudi
- Department of Ophthalmology, Gilan University of Medical Sciences, Rasht, Iran
| | - Fereydoun Farrahi
- Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Mohammad Mehdi Parvaresh
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Fesharaki
- Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Abrishami
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasser Shoeibi
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mansour Rahimi
- Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Javadzadeh
- Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Karkhaneh
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Riazi-Esfahani
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Maleki
- Department of Ophthalmology, Al Zahra Eye Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Razeghinejad MR, Masoumpour M, Eghbal MH, Myers JS, Moster MR. Glaucoma Surgery in Pregnancy: A Case Series and Literature Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:437-45. [PMID: 27582594 PMCID: PMC4967489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Glaucoma management in pregnant patients is a real challenge, especially when the glaucoma is not controlled with medications. We report the results of 6 incisional glaucoma surgeries for the management of medically uncontrolled glaucoma patients during pregnancy. This retrospective, case series was conducted on the 6 eyes of 3pregnant patients with uncontrolled glaucoma using maximum tolerable medications. Details of the glaucoma surgical management of these patients as well as their postoperative care and pregnancy and clinical outcomes on longitudinal follow-up are discussed. All 3 patients had juvenile open-angle glaucoma and were on various anti-glaucoma medications, including oral acetazolamide. The first case described underwent trabeculectomy without antimetabolites in both eyes because of uncontrolled intraocular pressure with topical medications. The surgery was done with topical lidocaine jelly and subconjunctival lidocaine during the second and third trimesters. The second patient had an Ahmed valve implantation in both eyes during the second and third trimesters because of uncontrolled IOP with topical medications and no response to selective laser trabeculoplasty. Surgery was done with topical tetracaine and subconjunctival and sub-Tenon's lidocaine. The third case had a Baerveldt valve implantation under general anesthesia in the second trimester. In selected pregnant glaucoma patients with medically uncontrolled intraocular pressure threatening vision, incisional surgery may lead to good outcomes for the patient with no risk for the fetus.
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Affiliation(s)
- Mohammad Reza Razeghinejad
- Poostchi Eye Research Center, Poostchi Clinic, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Mohammad Reza Razeghinejad, MD; Department of Ophthalmology, Khlaili Hospital, Poostchi Clinic, Zand Street, Zip Code: 71936-16642, Shiraz, Iran Tel/Fax: +98 71 36291779
| | - Masoumeh Masoumpour
- Poostchi Eye Research Center, Poostchi Clinic, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Eghbal
- Department of Anesthesiology, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jonathan S. Myers
- Glaucoma Service, Wills Eye Institute, Jefferson Medical College, Philadelphia, USA
| | - Marlene R. Moster
- Glaucoma Service, Wills Eye Institute, Jefferson Medical College, Philadelphia, USA
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Morrison JL, Hodgson LA, Lim LL, Al-Qureshi S. Diabetic retinopathy in pregnancy: a review. Clin Exp Ophthalmol 2016; 44:321-34. [PMID: 27062093 DOI: 10.1111/ceo.12760] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 03/24/2016] [Accepted: 04/02/2016] [Indexed: 12/15/2022]
Abstract
The prevalence of diabetes in pregnancy is increasing. Pre-existing diabetes is present in 1 in 167 pregnancies in Australia, divided equally between type 1 and type 2 diabetes. Diabetic retinopathy is a leading cause of blindness in women during their childbearing years, and pregnancy increases the short-term risk of diabetic retinopathy progression. We examine the risk factors for progression of diabetic retinopathy during pregnancy including duration of diabetes, baseline level of retinopathy, level of glycaemic control and hypertension. We also examine current screening and management guidelines and their levels of evidence, current treatment options for diabetic retinopathy and avenues for further research.
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Affiliation(s)
- Julie L Morrison
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Division of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Lauren Ab Hodgson
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Division of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Lyndell L Lim
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Division of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Medical Retina Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Salmaan Al-Qureshi
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Division of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Medical Retina Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
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