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Soullane S, Rhéaume MA, Auger N. Preeclampsia and the Retina. Curr Hypertens Rep 2024; 26:169-174. [PMID: 38133842 DOI: 10.1007/s11906-023-01290-0] [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] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW This review summarizes key findings relating to the association between preeclampsia and retinal disorders. RECENT FINDINGS Preeclampsia is a major cause of maternal morbidity. Pregnant women with preeclampsia frequently describe having visual disturbances. Retinal changes can be identified on fundoscopy in most patients with preeclampsia. While retinal pathology secondary to preeclampsia usually resolves postpartum, there is growing evidence that women with preeclampsia have a higher long-term risk of developing retinal disorders after pregnancy. Pregnant women often experience visual changes. While these symptoms may be benign, careful attention should be paid to exclude retinal disorders secondary to preeclampsia. Pregnant women complaining of new-onset or worsening blurry vision, scotomata, diplopia, or photopsia require rapid and thorough evaluation to rule out hypertensive disorders. Management of preeclampsia, including administration of magnesium sulfate and delivery of the fetus, can reverse retinal pathologies in most cases.
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Affiliation(s)
- Safiya Soullane
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
| | - Marc-André Rhéaume
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Department of Ophthalmology, University of Montreal, Montreal, QC, Canada
| | - Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.
- Institut national de santé publique du Québec, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
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Alonso-Santander N, Ortega-Usobiaga J, Beltrán-Sanz J, Druchkiv V, Llovet-Osuna F, Baviera-Sabater J. Laser in situ keratomileusis and surface ablation in pregnancy. J Fr Ophtalmol 2023; 46:114-122. [PMID: 36670012 DOI: 10.1016/j.jfo.2022.07.011] [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: 02/04/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Although corneal refractive surgery is contraindicated during pregnancy, some patients are unaware that they are pregnant when they undergo surgery. Our objectives were to determine the functional outcomes of corneal refractive surgery during pregnancy and to compare the results with those of nonpregnant women. METHODS We performed a multicenter, retrospective, interventional case series review of patients who were pregnant and who underwent laser in situ keratomileusis (LASIK) or surface ablation (photorefractive keratectomy, PRK) from September 11, 2002 to December 12, 2020 (group 1, n=82 eyes). Patients were included consecutively. Findings were compared with those of nonpregnant women (group 2, n=164 eyes). Functional (visual and refractive) outcomes are described. Follow-up was at least 550 days (control group, median [IQR], 990 days [715-1496]; study group, 895 days [709-1310]). The setting was Clínica Baviera, Spain, (AIER Eye Hospital Group). RESULTS A statistically significant difference was found between the groups in terms of efficacy index (EI). No complications of pregnancy or labor were reported. Similarly, a search of medical records revealed no adverse effects in the infants. CONCLUSIONS To the best of our knowledge, this is the first case series on pregnancy and refractive surgery. We do not recommend performing LASIK or surface ablation on pregnant women. Our objective in the present study was to present relevant scientific data obtained from women who underwent refractive surgery while unaware that they were pregnant.
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Affiliation(s)
| | | | - J Beltrán-Sanz
- Clínica Baviera, (AIER Eye Hospital Group), Burgos, Spain
| | - V Druchkiv
- Clínica Baviera, (AIER Eye Hospital Group), Burgos, Spain
| | - F Llovet-Osuna
- Clínica Baviera, (AIER Eye Hospital Group), Burgos, Spain
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Diress M, Getnet M, Akalu Y, Dagnew B, Belsti Y, Gela YY, Chilot D, Belay DG, Bitew DA, Terefe B, Getahun AB. Myopia and its associated factors among pregnant women at health institutions in Gondar District, Northwest Ethiopia: A multi-center cross-sectional study. Front Glob Womens Health 2023; 3:1078557. [PMID: 36727043 PMCID: PMC9884705 DOI: 10.3389/fgwh.2022.1078557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Background Myopia is the most common form of uncorrected refractive error with a growing burden worldwide. It is the principal complaint of most women during pregnancy. Although myopia has led to several consequences across the standard life of pregnant women, there is no previous study in Ethiopia regarding this topic. Thus, this study determined the prevalence of myopia and identifies its associated factors among pregnant women attending antenatal care units at governmental health institutions in Gondar City District, Northwest Ethiopia. Methods An institution-based cross-sectional study design was conducted from 08 February to 08 April 2021. From the selected health centres, study participants were recruited by systematic random sampling technique. A pre-tested, structured-interviewer-administered questionnaire consisting of socio-demographic variables, obstetric and clinical-related variables was used to collect the required data. Non-cycloplegic refraction was performed using trial lenses, trial frames, and retinoscopy in a semi-dark examination room. EpiData 3 and STATA 14 were used for data entry and statistical analysis respectively. Both bivariable and multivariable binary logistic regression analyses were executed to identify associated factors of myopia. Variables with a p-value ≤0.05 in the multivariable logistic regression analysis were declared as statistically significant with myopia. Model fitness was checked by Hosmer and Lemeshow goodness of test (at p > 0.05). Results A total of four-hundred and twenty-three pregnant women participated with a 100% response rate in this study. The overall prevalence of myopia among pregnant women was 26.48% (95% CI: 22.48-30.91). Eighty-Eight (20.81%) and Eighty-Four (19.85%) of the study participants had myopia in their right and left eyes respectively. The prevalence of myopia was significantly associated with age (AOR = 1.17; 95% CI: 1.09-1.28), the third trimester of gestation (AOR = 2.05, 95% CI: 1.08-3.90), multi & grand multipara (AOR = 3.15; 95% CI: 1.59-6.25), and history of contraceptive use (AOR = 3.30; 95% CI: 1. 50-7.28). Conclusion The finding of our study shows that there is a higher prevalence of myopia among pregnant women in our study area. Further prospective analytical studies regarding visual systems among pregnant women, particularly as a result of pregnancy, are strongly recommended.
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Affiliation(s)
- Mengistie Diress
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia,Correspondence: Mengistie Diress
| | - Mihret Getnet
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia
| | - Yonas Akalu
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia
| | - Baye Dagnew
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia
| | - Yitayeh Belsti
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia,Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | | | - Dagmawi Chilot
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia,Department of Human Anatomy, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Desalegn Anmut Bitew
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, University of Gondar, Gondar, Ethiopia
| | - Amare Belete Getahun
- Department of Anesthesia, School of Medicine, University of Gondar, Gondar, Ethiopia
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Subjective Dry Eye Symptoms in Pregnant Women-A SPEED Survey. J Pregnancy 2023; 2023:3421269. [PMID: 36643075 PMCID: PMC9833932 DOI: 10.1155/2023/3421269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 01/05/2023] Open
Abstract
Aim Multisystemic physiological changes in pregnancy can result in tear film and refractive changes in the eye. We report dry eye prevalence in pregnant women using Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire. Methods The SPEED questionnaire was self-administered cross-sectionally to 428 pregnant women (mean age: 26.8 ± 4.4 years) with clinically confirmed pregnancy from two obstetric clinics in Chennai, India. Subjects with predisposing risk factors for dry eye were excluded from the study. Subjects were categorized as normal, moderate, and severe dry eye based on the SPEED score. Results Among the women, 48.5% of the subjects had symptoms like dryness, grittiness or scratchiness, soreness or irritation, burning or watering, or eye fatigue. About 2.3% had moderate dry eye according to SPEED questionnaire criteria. Eye fatigue was the most reported symptom and was present in 76.4% of women. The symptom frequency score and severity score had a strong and significant correlation (r = 0.95, P < .001). No significant correlation was noted among SPEED score vs age (r = -0.02, P > .05). No significant correlation was found between symptoms of dry eye and gravidity (ρ = -0.006, P > .05) and trimester (ρ = 0.38, P > .05). Binary logistic regression showed that only occupational status and systemic condition was significantly associated with dry eye symptoms. Conclusion About half the pregnant women at the visit reported having one or more dry eye-related symptoms. As per the composite SPEED questionnaire score, dry eye was not prevalent among pregnant women irrespective of their age, gravidity, and the trimester, but we found a majority of pregnant women reported to have experienced dry eye-related symptoms, though tolerable. Awareness about dry eye during pregnancy will improve eye care seeking behaviour in pregnant women.
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Zamorano-Martín F, Sánchez-González JM, García-Lorente M, Rachwani-Anil R, Peraza-Nieves J, Rodríguez-Calvo-de-Mora M, Borroni D, Rocha-de-Lossada C. Laser refractive surgery in pregnant or breastfeeding patients. J Cataract Refract Surg 2021; 47:1081-1087. [PMID: 34292893 DOI: 10.1097/j.jcrs.0000000000000606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
This systematic review reported the outcomes of laser corneal refractive surgery in pregnant or breastfeeding patients. This study was performed by searching in PubMed, Web of Science, and Scopus databases, on June 15, 2020. Included were 128 eyes from a total of 64 patients, with the mean maximum follow-up was 39.2 ± 36.14 months. Time from surgery to complication ranged from 1 to 67 months, with a mean value of 23.42 ± 22.23 months. Photorefractive keratectomy and laser in situ keratomileusis surgery seem to be stable procedures that are not modified during pregnancy and safe to complete during breastfeeding. Nevertheless, the lack of weight prospective research avoids having a greater certainty on this matter, and because of transitory nature of pregnancy and breastfeeding, it could still be contemplated that surgery risk outweigh the benefits. Additional investigation will be necessary to clarify these issues.
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Affiliation(s)
- Francisco Zamorano-Martín
- From the Department of Ophthalmology, Regional University Hospital of Malaga, Malaga, Spain (Zamorano-Martín, García-Lorente, Rachwani-Anil); Department of Physics of Condensed Matter, Optics Area, University of Seville, Seville, Spain (Sánchez-González); Department of Ophthalmology (Tecnolaser Clinic Vision), Refractive Surgery Centre, Seville, Spain (Sánchez-González); Department of Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain (Peraza-Nieves); Department of Doctoral Studies, Riga Stradins University, Riga, Latvia (Borroni); Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, United Kingdom (Borroni); Department of Ophthalmology, Hospital Universitario Virgen de las Nieves, Granada, Spain (Rocha-de-Lossada); Department of Ophthalmology, University of Malaga, Malaga, Spain (Rocha-de-Lossada)
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Diress M, Yeshaw Y, Bantihun M, Dagnew B, Ambelu A, Seid MA, Akalu Y. Refractive error and its associated factors among pregnant women attending antenatal care unit at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. PLoS One 2021; 16:e0246174. [PMID: 33577552 PMCID: PMC7880455 DOI: 10.1371/journal.pone.0246174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Refractive error is one of the commonly encountered problems during pregnancy and being the cause of deleterious effects on health. Despite its impacts, there is no evidence on the magnitude and associated factors of refractive error among pregnant women in Ethiopia. This study aimed to determine the prevalence of refractive error and its associated factors among pregnant women attending antenatal care unit at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2020. Methods An institution-based cross-sectional study was employed. An ocular examination was performed using Retinoscope and Snellen’s illiterate “E” chart. The required data were collected using an interviewer-administered questionnaire which comprised socio-demographic, clinical and pregnancy-related variables. EpiData 3.02 and STATA 14 were used for data entry and analysis respectively. Both bivariable and multivariable binary logistic regression analyses were executed to identify factors associated with refractive error. Variables with a p-value ≤ 0.05 in the multivariable logistic regression analysis were declared as significantly associated factors with refractive error. Results A total of 401 pregnant women with a median age of 27 (IQR = 24–31) years participated in this study. The overall prevalence of refractive error among the study participants was 35.66% (95% CI: 30.95–40.37). Of the total study participants, ninety-two (22.90%) of them were myopic, forty-five (11.22%) were hyperopic and the rest were antimetropic. Increased maternal age (AOR = 1.31; 95% CI: 1.16–1.48)), increased parity (AOR = 3.17, 95% CI: 1.92–5.25), increased gestational age (AOR = 1.15, 95% CI: 1.08–1.22), and regular use of computers/ watching television (AOR = 6.19, 95% CI: 2.46–15.59) were significantly associated with refractive error. Conclusion The prevalence of refractive error among pregnant women was high where myopia was the most common variety. Advanced maternal age, increased gestational age, increased parity and regular use of computer or watching television were significantly associated with refractive error among pregnant women. Therefore, apart from providing other maternal health services, routine screening and evaluation of pregnant women for refractive error during antenatal care visit is recommended to avoid its negative impacts.
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Affiliation(s)
- Mengistie Diress
- Department of Human Physiology, School of Medicine, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Yigizie Yeshaw
- Department of Human Physiology, School of Medicine, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Minychil Bantihun
- Department of Optometry, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Baye Dagnew
- Department of Human Physiology, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Ambelu
- Department of Human Physiology, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Mohammed Abdu Seid
- Department of Human Physiology, School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yonas Akalu
- Department of Human Physiology, School of Medicine, University of Gondar, Gondar, Ethiopia
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Wu F, Schallhorn JM, Lowry EA. Refractive status during pregnancy in the United States: results from NHANES 2005-2008. Graefes Arch Clin Exp Ophthalmol 2019; 258:663-667. [PMID: 31823061 DOI: 10.1007/s00417-019-04552-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Anecdotal reports of refractive changes in pregnancy are familiar to optometrists and ophthalmologists. Refractive stability during pregnancy has implications in both prescribing of refractive correction and candidacy for refractive surgery. This study aims to examine refractive status in a nationally representative sample of US pregnant women. METHODS The National Health and Nutrition Examination Survey (NHANES) is a weighted, stratified, cross-sectional survey of the US population conducted every 2 years. During 2005-2006 and 2007-2008, the exam included multiple ophthalmic tests including refraction, keratometry, and lensometry. Female participants aged 20-44 years with available vision examination data were included in the study. Subjects were excluded if best obtainable visual acuity was worse than 20/40 or there was prior history of cataract or refractive surgery. The primary outcome was defined as refractive change stratified by trimester of pregnancy. RESULTS 301 pregnant women were matched with 301 nonpregnant controls based on age, ethnicity, and education. There was no difference in refractive error between pregnant women and matched nonpregnant controls (all p > 0.99). For the refractive change analysis, a subgroup of 60 pregnant subjects with glasses at presentation was matched to 60 nonpregnant controls. Multivariate regression showed a significant increase in refractive change versus prior to glasses prescription by trimester of pregnancy (p = 0.02), though this change was not in a specific direction (i.e., no significant shift toward either myopia or hyperopia). CONCLUSIONS Pregnant women have greater refractive difference from prior spectacle prescription later in pregnancy, but the direction of this change is variable and not significant. This finding may reflect a longer time to last glasses prescription later in pregnancy, given concerns that refractive error fluctuates in pregnancy. Additional longitudinal studies are needed to better characterize the effects of pregnancy on refractive status.
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Affiliation(s)
- Frances Wu
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Julie M Schallhorn
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,F.I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Eugene A Lowry
- Legacy Health Services, Devers Eye Institute, Post: 1040 NW 22nd Ave #200, Portland, OR, 97210, USA. .,Casey Eye Institute, Oregon Health and Sciences University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA.
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Nuzzi R, Scalabrin S, Becco A, Panzica G. Sex Hormones and Optic Nerve Disorders: A Review. Front Neurosci 2019; 13:57. [PMID: 30804741 PMCID: PMC6378504 DOI: 10.3389/fnins.2019.00057] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/21/2019] [Indexed: 01/31/2023] Open
Abstract
Aim: This review article presents a comprehensive overview of the literature on sex hormones (estrogens, androgens, progesterone) and optic nerve disorders, with a discussion of the implications for therapy and prevention. Methods: Epidemiological, pre-clinical and clinical studies were reviewed. Results: Analysis of the biological basis for a relationship between eye diseases and sex hormones showed that some types of hormones can exert a protective effect either directly on the retina and optic nerve or indirectly by modulating ocular blood flow. For example, it seems that estrogen exposure has a protective effect against glaucoma, whereas its deficit may lead to early onset of the disease. If further studies confirm the data in the literature, estrogen therapy, because of its antioxidant action, may be effective in the treatment of Leber's hereditary optic neuropathy, whereas, in the light of current studies, there does not seem to be an influence of estrogen on non-arteritic anterior ischemic optic neuritis (NAION). Conclusions: Although there is some evidence that in some optic nerve pathologies the sex hormones seem to play an important role there are still too few studies providing evidence for its wider use in clinical practice.
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Affiliation(s)
- Raffaele Nuzzi
- Eye Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Ophtalmic Clinic, University of Turin, Turin, Italy
| | - Simona Scalabrin
- Eye Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Ophtalmic Clinic, University of Turin, Turin, Italy
| | - Alice Becco
- Eye Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Ophtalmic Clinic, University of Turin, Turin, Italy
| | - Giancarlo Panzica
- Laboratory of Neuroendocrinology, Department of Neuroscience Rita Levi-Montalcini, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri-Ottolenghi, Orbassano, Italy
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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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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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Knowledge, attitude and practices of Ghanaian midwives regarding the use of ophthalmic medications among pregnant women. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: 10.1016/j.ijans.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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13
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Refractive Errors & Refractive Surgery Preferred Practice Pattern®. Ophthalmology 2018; 125:P1-P104. [DOI: 10.1016/j.ophtha.2017.10.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022] Open
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Mohammadi SF, Letafat-Nejad M, Ashrafi E, Delshad-Aghdam H. A survey of ophthalmologists and gynecologists regarding termination of pregnancy and choice of delivery mode in the presence of eye diseases. J Curr Ophthalmol 2017; 29:126-132. [PMID: 28626823 PMCID: PMC5463005 DOI: 10.1016/j.joco.2016.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/23/2016] [Accepted: 09/30/2016] [Indexed: 11/02/2022] Open
Abstract
PURPOSE To evaluate and compare the attitudes of ophthalmologists and gynecologists in suggesting appropriate approach to pregnancy in different ocular conditions. METHODS Specialty-specific questionnaires on delivery mode and abortion indications for ophthalmic patients (refractive, vascular, oncologic, retinal, glaucoma, postoperation, posttrauma, and infectious) were designed and distributed among physician staff of Farabi Eye Hospital and Yas Women Hospital in Tehran. Attitudes and preferences of the ophthalmologists and gynecologists were quantified and compared. RESULTS Participants were 29 ophthalmologists and 19 gynecologists. Their mean age was 49.73 ± 7.57 and 46.79 ± 1.36 years, respectively. More than 50-70% ophthalmologists were in favor of normal vaginal delivery (NVD) in all ocular diseases. All gynecologists (100%) expressed their need for an ophthalmologist's opinion for decision-making. Ophthalmologists' top choices for conditions potentially requiring a caesarean section were corneal transplants (34.5%), high myopia (23%), retinal detachment (29%), and orbital tumors (34.5%), while two gynecologists recommended abortion in the presence of intraocular and orbital tumors and retinal detachment. In the case of a history of refractive surgery, orbital tumor and intraocular tumor, ophthalmologists recommend NVD over caesarean section twice as much as their gynecologist peers. For history of retinal detachment, glaucoma, retinal vascular accident and intraocular hemorrhage, no single gynecologist recommend NVD. The corresponding figure for ophthalmologist-recommended NVD were 67, 84, 72, and 81%. CONCLUSIONS There is extreme inconsistency among ophthalmologists and gynecologists in managing ophthalmic-obstetric scenarios, especially for caesarean section indications. Clinical guideline development and consultation for decision-making in challenging cases are recommended.
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Affiliation(s)
| | | | | | - Hanieh Delshad-Aghdam
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Ataş M, Duru N, Ulusoy DM, Altınkaynak H, Duru Z, Açmaz G, Ataş FK, Zararsız G. Evaluation of anterior segment parameters during and after pregnancy. Cont Lens Anterior Eye 2014; 37:447-50. [DOI: 10.1016/j.clae.2014.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/31/2014] [Accepted: 07/21/2014] [Indexed: 11/16/2022]
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Mackensen F, Paulus WE, Max R, Ness T. Ocular changes during pregnancy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:567-75; quiz 576. [PMID: 25220071 PMCID: PMC4165189 DOI: 10.3238/arztebl.2014.0567] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most ocular changes in pregnancy are harmless. For example, 14% of pregnant women need a new eyeglass prescription. Some changes, however, are serious, such as retinal effects of hypertension, which can be a sign of pre-eclampsia. Ocular changes may give rise to uncertainty about the administration of ophthalmological drugs or the optimal method of childbirth. METHOD This review is based on pertinent literature retrieved by a selective search in Medline and on guidelines from Germany and abroad. Recommendations about drugs were taken from the Embryotox and Reprotox databases, the German Red List, and the United States Food and Drug Administration (FDA). RESULTS 40% to 100% of pregnant women with high blood pressure have retinal changes whose severity is correlated with the severity of pre-eclampsia or eclampsia. Diabetic women should undergo ocular examination before and during pregnancy. Pre-existing retinal changes worsen during pregnancy in 55% of cases. Most ocular diseases can be treated with the usual drugs in pregnant women and nursing mothers, although the evidence for drug safety is derived from case series and the treatment is usually provided off label. Ocular conditions that are present before pregnancy are irrelevant to the choice of a method of childbirth. CONCLUSION Pregnant women and nursing mothers can undergo most types of ophthalmological examination and treatment. Recommendations about drug treatment should be checked against current information that can be found on the embryotox.de and reprotox.de websites.
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Affiliation(s)
- Friederike Mackensen
- Interdisciplinary Uveitis Center, Department of Ophthalmology, University of Heidelberg
| | | | - Regina Max
- Department of Internal Medicine V: Rheumatology, Interdisciplinary Uveitis Center, University of Heidelberg
| | - Thomas Ness
- Department of Ophthalmology, University of Freiburg i. Brsg
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López-Prats MJ, Hidalgo-Mora JJ, Sanz-Marco E, Pellicer A, Perales A, Díaz-Llopis M. [Influence of pregnancy on refractive parameters after LASIK surgery]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2012; 87:173-178. [PMID: 22633608 DOI: 10.1016/j.oftal.2011.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 08/05/2011] [Accepted: 09/11/2011] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Different ocular changes and complications of refractive surgery such as photorefractive keratectomy (PRK) due to pregnancy have been described in the last few years. However there is no information about the possible problems of laser in situ keratomileusis (LASIK) in pregnant women. Our objective was to study how physiological changes secondary to pregnancy could alter the refractive situation in pregnant women who have undergone LASIK surgery. We show the results obtained due to the changes between the first two trimesters of the pregnancy. METHODS A prospective and observational study was conducted in which one study group, made up of 9 patients who had undergone LASIK surgery before becoming pregnant, was compared with a control group of 9 patients with non-surgically corrected refractive problems. The following measurements were made in both groups in the first and second trimesters of the pregnancy; visual acuity, the best corrected visual acuity, tonometry, ocular anatomical characteristics by biometry, and refractive and corneal study by Pentacam(®). RESULTS Signicant changes were observed in the cylinder and spherical equivalent between the two trimesters in both groups. Visual acuity and spherical equivalent show a strong trend towards worsening, which was more significant in the study group. The patients of this group who had a larger pre-surgical defect showed lower modifications during the six first months of pregnancy. CONCLUSIONS The majority of women who require laser refractive surgery are are between 20-30 years old, thus in many cases corneal surgery is followed by at least one pregnancy, with different possible ophthalmological effects. The conclusions that may be derived from this study are that the assessment of the refractive changes in surgically operated corneas may be biomechanically weakened on being subjected to physiological hormone stimulation as happens during gestation.
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Affiliation(s)
- M J López-Prats
- Servicio de Oftalmología, Hospital Universitario La Fe, Valencia, España.
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Rim HT, Park SY, Yoon JS. Hormone Replacement Therapy and Eye Diseases: KNHANES IV. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.10.1445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyung Taek Rim
- Department of Ophthalmology, Yonsei University College of Medicine, Institute of Vision Research, Seoul, Korea
| | - Sun Young Park
- Department of Ophthalmology, Yonsei University College of Medicine, Institute of Vision Research, Seoul, Korea
| | - Jin Sook Yoon
- Department of Ophthalmology, Yonsei University College of Medicine, Institute of Vision Research, Seoul, Korea
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Abstract
Pregnancy may cause ocular changes, for example refractive changes or contact lens intolerance. A number of ocular diseases may deteriorate. Especially preexisting diabetic retinopathy may worsen. Vaginal delivery is nearly always possible. Caesarean section is not required due to myopia, peripheral retinal degenerations or after retinal surgery. Most topically applied drugs usually used in ophthalmology are safe during pregnancy.
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Affiliation(s)
- T Ness
- Schwerpunkt Uveitis, Universitäts-Augenklinik Freiburg, Killianstr. 5, 79106, Freiburg.
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Laser literature watch. Photomed Laser Surg 2006; 24:661-76. [PMID: 17069502 DOI: 10.1089/pho.2006.24.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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