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Omar A, Williams RG, Whelan J, Noble J, Brent MH, Giunta M, Olivier S, Lhor M. Diabetic Disease of the Eye in Canada: Consensus Statements from a Retina Specialist Working Group. Ophthalmol Ther 2024; 13:1071-1102. [PMID: 38526804 DOI: 10.1007/s40123-024-00923-0] [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: 01/31/2024] [Accepted: 02/29/2024] [Indexed: 03/27/2024] Open
Abstract
Despite advances in systemic care, diabetic disease of the eye (DDE) remains the leading cause of blindness worldwide. There is a critical gap of up-to-date, evidence-based guidance for ophthalmologists in Canada that includes evidence from recent randomized controlled trials. Previous guidance has not always given special consideration to applying treatments and managing DDE in the context of the healthcare system. This consensus statement aims to assist practitioners in the field by providing a spectrum of acceptable opinions on DDE treatment and management from recognized experts in the field. In compiling evidence and generating consensus, a working group of retinal specialists in Canada addressed clinical questions surrounding the four themes of disease, patient, management, and collaboration. The working group reviewed literature representing the highest level of evidence on DDE and shared their opinions on topics surrounding the epidemiology and pathophysiology of diabetic retinopathy and diabetic macular edema; diagnosis and monitoring; considerations around diabetes medication use; strategic considerations for management given systemic comorbidities, ocular comorbidities, and pregnancy; treatment goals and modalities for diabetic macular edema, non-proliferative and proliferative diabetic retinopathy, and retinal detachment; and interdisciplinary collaboration. Ultimately, this work highlighted that the retinal examination in DDE not only informs the treating ophthalmologist but can serve as a global index for disease progression across many tissues of the body. It highlighted further that DDE can be treated regardless of diabetic control, that a systemic approach to patient care will result in the best health outcomes, and prevention of visual complications requires a multidisciplinary management approach. Ophthalmologists must tailor their clinical approach to the needs and circumstances of individual patients and work within the realities of their healthcare setting.
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Affiliation(s)
- Amer Omar
- Medical Retina Institute of Montreal, 2170 René-Lévesque Blvd Ouest, Bureau 101, Montréal, QC, H3H 2T8, Canada.
| | - R Geoff Williams
- Calgary Retina Consultants, University of Calgary, Calgary, AB, Canada
| | - James Whelan
- Faculty of Medicine, Memorial University, St. John's, NF, Canada
| | - Jason Noble
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, ON, Canada
| | - Michael H Brent
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, ON, Canada
| | - Michel Giunta
- Department of Ophthalmology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Sébastien Olivier
- Centre Universitaire d'ophtalmologie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Mustapha Lhor
- Medical and Scientific Affairs Ophthalmology, Bayer Inc., Mississauga, ON, Canada
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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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3
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Pandya M, Banait S, Daigavane S. Insights Into Visual Rehabilitation: Pan-Retinal Photocoagulation for Proliferative Diabetic Retinopathy. Cureus 2024; 16:e54273. [PMID: 38496130 PMCID: PMC10944551 DOI: 10.7759/cureus.54273] [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: 12/24/2023] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
This review comprehensively explores pan-retinal photocoagulation (PRP) as a pivotal intervention in visually rehabilitating individuals afflicted with proliferative diabetic retinopathy (PDR). The review begins by elucidating the significance of PDR within the spectrum of diabetic retinopathy (DR), emphasizing the progressive nature of the disease and the consequential impact on visual health. A detailed analysis of PRP follows, encompassing its definition, purpose, and historical development, shedding light on the procedural intricacies and mechanisms of action. The postoperative care and follow-up section underscores the necessity of vigilant monitoring for complications, visual recovery, and the importance of regular ophthalmic check-ups. The subsequent discussion delves into patient education and counseling, stressing the need to manage expectations, encourage lifestyle modifications, and highlight the significance of follow-up appointments. The review concludes with insights into future directions, including advancements in laser technology and emerging therapies, offering a glimpse into the evolving landscape of DR management. By addressing ongoing challenges and embracing innovative approaches, this review provides a comprehensive guide for clinicians, researchers, and healthcare practitioners who visually rehabilitate individuals struggling with PDR.
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Affiliation(s)
- Meghavi Pandya
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shashank Banait
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sachin Daigavane
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Lee H, Yang SW, Kim Y, Shin H, Seo YS, Oh MJ, Choi S, Cho GJ, Hwang HS. Risk of retinopathy in women with pregnancy-induced hypertension: a nationwide population-based cohort study of 9-year follow-up after delivery. Am J Obstet Gynecol MFM 2023; 5:100985. [PMID: 37119970 DOI: 10.1016/j.ajogmf.2023.100985] [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: 02/02/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND The retina is potentially associated with several physiological, hormonal, and metabolic changes during pregnancy. The few available epidemiologic studies of ocular changes in pregnancy have mainly concerned retinopathies. Pregnancy-induced hypertension, which leads to ocular manifestations including blurred vision, photopsia, scotoma, and diplopia, might induce reactive changes in the retinal vessels. Although several studies have suggested the existence of pregnancy-induced hypertension-related retinal ocular disease, there are few large cohort studies on this topic. OBJECTIVE This study aimed to investigate the risk of major retinal diseases including central serous chorioretinopathy, diabetic retinopathy, retinal vein occlusion, retinal artery occlusion, and hypertensive retinopathy in the long-term postpartum stage according to the presence of previous pregnancy-induced hypertension in a large cohort based on the Korean National Health Insurance Database. STUDY DESIGN On the basis of Korean health data, 909,520 patients who delivered from 2012 to 2013 were analyzed. Among them, patients who had previous ocular diseases or hypertension and multiple births were excluded. Finally, 858,057 mothers were assessed for central serous chorioretinopathy (ICD-10: H35.70), diabetic retinopathy (ICD-10: H36.0, E10.31, E10.32, E11.31, E11.32, E12.31, E13.31, E13.32, E14.31, E14.32), retinal vein occlusion (ICD-10: H34.8), retinal artery occlusion (ICD-10: H34.2), and hypertensive retinopathy (ICD-10: H35.02) for 9 years after delivery. Enrolled patients were divided into 2 groups: 10,808 patients with and 847,249 without pregnancy-induced hypertension. The primary outcomes were the incidence of central serous chorioretinopathy, diabetic retinopathy, retinal vein occlusion, retinal artery occlusion, and hypertensive retinopathy 9 years after delivery. Clinical variables were age, parity, cesarean delivery, gestational diabetes mellitus, and postpartum hemorrhage. In addition, pregestational diabetes mellitus, kidney diseases, cerebrovascular diseases, and cardiovascular diseases were adjusted. RESULTS Postpartum retinal disease during the 9 years after delivery and total retinal diseases showed higher rates in patients with pregnancy-induced hypertension. In detail, the rates of central serous chorioretinopathy (0.3% vs 0.1%), diabetic retinopathy (1.79% vs 0.5%), retinal vein occlusion (0.19% vs 0.1%), and hypertensive retinopathy (0.62% vs 0.05%) were higher than those found in patients without pregnancy-induced hypertension. After adjusting for confounding factors, pregnancy-induced hypertension was associated with development of postpartum retinopathy, with a >2-fold increase (hazard ratio, 2.845; 95% confidence interval, 2.54-3.188). Furthermore, pregnancy-induced hypertension affected the development of central serous chorioretinopathy (hazard ratio, 3.681; 95% confidence interval, 2.667-5.082), diabetic retinopathy (hazard ratio, 2.326; 95% confidence interval, 2.013-2.688), retinal vein occlusion (hazard ratio, 2.241; 95% confidence interval, 1.491-3.368), and hypertensive retinopathy (hazard ratio, 11.392; 95% confidence interval, 8.771-14.796) after delivery. CONCLUSION A history of pregnancy-induced hypertension increases the risk of central serous chorioretinopathy, diabetic retinopathy, retinal vein occlusion, and hypertensive retinopathy according to 9-year long-term ophthalmologic follow-up.
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Affiliation(s)
- Hyungwoo Lee
- Department of Ophthalmology, Konkuk University School of Medicine, Seoul, Republic of Korea (Dr Lee)
| | - Seung-Woo Yang
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea (Drs Yang and Seo)
| | - Yeji Kim
- Department of Statistics, Korea University, Seoul, Republic of Korea (Ms Kim and Dr Choi)
| | - Hyunju Shin
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (Drs Shin, Oh, and Cho)
| | - Yong-Soo Seo
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea (Drs Yang and Seo)
| | - Min Jeong Oh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (Drs Shin, Oh, and Cho)
| | - Sangbum Choi
- Department of Statistics, Korea University, Seoul, Republic of Korea (Ms Kim and Dr Choi)
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (Drs Shin, Oh, and Cho).
| | - Han-Sung Hwang
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea (Dr Hwang).
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Igbokwe N, Benson G, Waireri J. Bernard-Soulier syndrome in pregnancy with retinal detachment: a rare phenomenon. BMJ Case Rep 2022; 15:e250405. [PMID: 36129357 PMCID: PMC9438107 DOI: 10.1136/bcr-2022-250405] [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: 11/04/2022] Open
Abstract
Bernard-Soulier syndrome (BSS) is a rare congenital bleeding disorder of the platelet, and it is mainly inherited as an autosomal recessive trait. It is caused by both qualitative and quantitative deficiency of the platelet membrane glycoprotein (GP) Ib-IX-V receptor complex, thereby causing abnormal platelets adhesion.We report a case of a primigravida in her 20s with history of BSS diagnosed in childhood due to family history. Her preconception period was challenging as she suffered from severe menorrhagia often requiring hospital admission, blood and platelet transfusions.At 35 weeks gestation, she developed temporal crowded retinal detachment of the left eye and had a successful left scleral buckling surgery under general anaesthesia (GA).She had a multidisciplinary team care with a successful elective GA caesarean section at 39+3 weeks gestation with peridelivery platelet transfusion and intravenous recombinant factor VIIa. Regional anaesthesia, intramuscular injections and anticoagulation were avoided.
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Affiliation(s)
- Nnadozie Igbokwe
- Centre for Reproductive Medicine and Surgery, St Bartholomew's Hospital, London, UK
| | - Gary Benson
- Haemophilia and Thrombosis Centre, Belfast City Hospital Health and Social Services Trust, Belfast, UK
| | - Joyce Waireri
- Obstetrics and gynaecology, Royal Jubilee Maternity Service, Belfast, UK
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Hu L, Li DH, Wang SY. A algorithm for prediction of exudative retinal detachment risk of patients with pregnancy-induced hypertension. Int J Ophthalmol 2022; 15:1310-1315. [PMID: 36017055 DOI: 10.18240/ijo.2022.08.13] [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: 05/21/2021] [Accepted: 03/28/2022] [Indexed: 12/11/2022] Open
Abstract
AIM To investigate the risk of exudative retinal detachment (ERD) morbidity in patients with pregnancy-induced hypertension (PIH) by using the logistic regression combined with the receiver operating characteristic (ROC) curve. METHODS A total of 46 patients with ERD and 142 patients with non-ERD were diagnosed as PIH from January 2017 to February 2020. A retrospective comparison of the clinical manifestations and laboratory tests were conducted. The risk of ERD morbidity with PIH was predicted by using logistic regression combined with an ROC curve model. RESULTS There was no significant difference in age and body mass index between the two groups before pregnancy (P>0.05). However, significant differences were found in gestational weeks, duration of hypertension, maximum and minimum systolic and diastolic blood pressure (BP), and plasma total protein (PTP) concentration between the two groups (P<0.05). Binary logistic regression analysis showed that the maximum systolic BP (OR=1.050, 95%CI: 1.016-1.085) and PTP concentration (OR=0.764, 95%CI: 0.702-0.832) were independent prediction risks of ERD in PIH. The sensitivities of maximum systolic BP, PTP concentration and combined diagnosis were 0.717, 0.870, and 0.870, respectively; the specificities were 0.617, 0.837, and 0.908, respectively; the area under the curve (AUC) was 0.707 (95%CI: 0.622-0.792), 0.917 (95%CI: 0.868-0.967), and 0.933 (95%CI: 0.890-0.975), respectively; the AUC of combined diagnosis was higher than that of single diagnosis (P<0.01). CONCLUSION Logistic regression and ROC curve model combined with maximum systolic BP and PTP can improve the early identification of high-risk PIH patients in the hospital.
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Affiliation(s)
- Li Hu
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Dong-Hao Li
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Shuang-Yong Wang
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
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Fairbanks JL, Lloyd RE, Dempsey SP. Case Report: Postpartum Purtscher-like Retinopathy. Optom Vis Sci 2021; 98:1304-1308. [PMID: 34510147 DOI: 10.1097/opx.0000000000001797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
SIGNIFICANCE This case highlights various clinical features and resolution of Purtscher-like retinopathy after childbirth. PURPOSE This study aimed to present a case report of postpartum Purtscher-like retinopathy and subsequent resolution after oral and intravitreal treatment. CASE REPORT A 30-year-old woman presented with subjective visual disturbance and transient scotoma in her right eye 7 days after giving birth. Vision measured 20/20 in her right eye and 20/20 in her left eye. Clinical examination revealed optic disc edema, retinal ischemia, and retinal hemorrhage in the right eye with a grossly normal appearance of the left eye. A diagnosis of Purtscher-like retinopathy was made. Neuroimaging and bloodwork were noncontributory to the diagnosis. Approximately 1 month after treatment with rapidly tapered oral methylprednisolone and a single intravitreal bevacizumab (Avastin; Genentech, San Francisco, CA) injection, the retinopathy had resolved with subjective visual improvement. CONCLUSIONS Purtscher-like retinopathy can occur after childbirth, usually within 1 to 2 days postpartum and occasionally associated with preeclampsia. Clinical course and visual improvement vary, but novel treatments may aid in visual recovery.
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Affiliation(s)
| | - Rachael E Lloyd
- Surgical & Specialty Clinic, Optometry, St. Cloud VA Hospital, St. Cloud, Minnesota
| | - Sean P Dempsey
- Surgical & Specialty Clinic, Optometry, St. Cloud VA Hospital, St. Cloud, Minnesota
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Figueira J, Henriques J, Carneiro Â, Marques-Neves C, Flores R, Castro-Sousa JP, Meireles A, Gomes N, Nascimento J, Amaro M, Silva R. Guidelines for the Management of Center-Involving Diabetic Macular Edema: Treatment Options and Patient Monitorization. Clin Ophthalmol 2021; 15:3221-3230. [PMID: 34354341 PMCID: PMC8331083 DOI: 10.2147/opth.s318026] [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] [Received: 04/29/2021] [Accepted: 06/15/2021] [Indexed: 02/05/2023] Open
Abstract
Diabetic macular edema (DME) is the main cause of visual impairment associated with diabetic retinopathy (DR) and macular laser, during approximately three decades, and was the single treatment option. More recently, intravitreous injections of anti-angiogenics and corticosteroids modified the treatment paradigm associated with significant vision improvements. Nevertheless, not all patients respond satisfactorily to anti-VEGF or corticosteroid injections, so an adequate treatment choice and a prompt switch in therapeutic class is recommended. Several algorithms and guidelines have been proposed for treating center involving DME to improve patients’ vision and quality of life. However, in Portugal, such guidelines are lacking. The present review aimed to provide guidelines for the treatment options and patient monitorization in the management of center-involving DME. We recommend anti-vascular endothelial growth factor (VEGF) as first-line therapy after a clinical evaluation accompanied by a rigorous metabolic control. Depending on the response obtained after 3–6 monthly intravitreal injections we suggest switching outside the class in case of a non-responder, maintaining the anti-VEGF-therapy in responders to anti-angiogenics. The treatment regimen for Dexamethasone intravitreal implant (DEXii) should be pro-re-nata with bi-monthly or quarterly monitoring visits (with a scheduled visit at 6–8 weeks after DEXii for intraocular pressure control). If a patient does not respond to DEXii, switch again to anti-VEGF therapy, combine therapies, or re-evaluate patients diagnose. There is a resilient need to understand the disease, its treatments, regimens available, and convenience for all involved to propose an adequate algorithm for the treatment of diabetic retinopathy (DR) and DME in an individualized regimen. Further understanding of the contributing factors to the development and progression of DR should bring new drug discoveries for more effective and better-tolerated treatments.
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Affiliation(s)
- João Figueira
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal.,AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - José Henriques
- Retina Department, Retinal Surgical Unit, Dr. Gama Pinto Ophthalmology Institute, Lisbon, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Carlos Marques-Neves
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE - Hospital de Santa Maria, Lisbon, Portugal.,Department of Ophthalmology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,ALM Oftalmolaser, Lisbon, Portugal
| | - Rita Flores
- Department of Ophthalmology, Centro Hospitalar de Lisboa Central EPE, Lisbon, Portugal.,CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal
| | - João Paulo Castro-Sousa
- Department of Ophthalmology, Centro Hospitalar de Leiria, Leiria, Portugal.,CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,Faculty of Medical Sciences, Universidade da Beira Interior, Covilhã, Portugal
| | - Angelina Meireles
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Nuno Gomes
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
| | - João Nascimento
- Instituto de Retina e Diabetes Oculares de Lisboa, Lisbon, Portugal
| | - Miguel Amaro
- Ophthalmology Department, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Rufino Silva
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal.,AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,Coimbra Medical Space, Coimbra, Portugal
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AlQahtani AS, Hazzazi MA, Waheeb SA, Semidey VA, Semidey VA, Elgendy HK, Alkhars WI, Abouammoh MA, Al-Dhibi H. Saudi Arabia Guidelines for diabetic macular edema: A consensus of the Saudi Retina Group. Saudi Med J 2021; 42:131-145. [PMID: 33563731 PMCID: PMC7989293 DOI: 10.15537/smj.2021.2.25623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022] Open
Abstract
Diabetes mellitus (DM) and its complications are major public health burdens in Saudi Arabia. The prevalence of diabetic retinopathy (DR) is 19.7% and the prevalence of diabetic macular edema (DME) is 5.7% in Saudi Arabia. Diabetic macular edema is a vision-threatening complication of DR and a major cause of vision loss worldwide. Ocular treatments include retinal laser photocoagulation, anti-vascular endothelial growth factor (anti-VEGF) agents, intravitreal corticosteroids, and vitreoretinal surgery when necessary. The present consensus was developed as a part of the Saudi Retina Group's efforts to generate Saudi guidelines and consensus for the management of DME, including recommendations for its diagnosis, treatment, and best practice. The experts' panel stipulates that the treatment algorithm should be categorized according to the presence of central macula involvement. In patients with no central macular involvement, laser photocoagulation is recommended as the first-line option. Patients with central macular involvement and no recent history of cardiovascular (CVS) or cerebrovascular disorders can be offered anti-VEGF agents as the first-line option. In the case of non-responders (defined as an improvement of <20% in optical coherence tomography or a gain of fewer than 5 letters in vision), switching to another anti-VEGF agent or steroids should be considered after 3 injections. Within the class of steroids, dexamethasone implants are recommended as the first choice. In patients with a recent history of CVS events, the use of anti-VEGF agents is not recommended, regardless of their lens status. The experts' panel recommends that a future study be conducted to provide a cut-off point for early switching to steroid implants in pseudo-phakic eyes.
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Affiliation(s)
- Abdullah S. AlQahtani
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Mohammad A. Hazzazi
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Saad A. Waheeb
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Valmore A. Semidey
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Valmore A. Semidey
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Hussein K. Elgendy
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Wajeeha I. Alkhars
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Marwan A. Abouammoh
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Hassan Al-Dhibi
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
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Pole C, Gaw Stephanie SL, Tsui Irena I. Utility of optical coherence tomography angiography in pregnancy-associated central serous chorioretinopathy. Am J Ophthalmol Case Rep 2020; 20:100979. [PMID: 33145456 PMCID: PMC7595881 DOI: 10.1016/j.ajoc.2020.100979] [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: 02/13/2020] [Revised: 08/25/2020] [Accepted: 10/18/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose To describe a case of pregnancy-related central serous chorioretinopathy (pCSCR) and the utility of monitoring with optical coherence tomography (OCT) and OCT angiography (OCTA). Observations A 34-year-old female in her third trimester of pregnancy presented with symptomatic visual disturbances of the right eye. Medical history was otherwise unremarkable. Optical coherence tomography (OCT) disclosed a serous retinal detachment with trace subretinal fibrin and elevation of the retinal pigment epithelium (RPE). OCT angiography (OCTA) demonstrated absence of choroidal neovascular membrane (CNV). It was decided to monitor with weekly OCTs until delivery, after which the patient had full resolution of symptoms and subretinal fluid. Conclusions and Importance Pregnancy-related CSCR may be complicated by fibrin deposition and RPE changes suspicious for CNV. This provides evidence of the utility of OCT for monitoring pCSCR progression and of OCTA to non-invasively assess presence of CNV. Pregnancy-related central serous chorioretinopathy (pCSCR) can be safely monitored using non-invasive imaging modalities. Optical coherence tomography angiography (OCTA) is useful to assess presence of choroidal neovascularization in pCSCR. Pregnancy is a risk factor for central serous chorioretinopathy (CSCR).
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Affiliation(s)
- Cameron Pole
- Retina Division, Stein Eye Institute, University of California Los Angeles, 200 Stein Plaza, Los Angeles, CA, 90095, USA
| | - Stephanie L Gaw Stephanie
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, 550 16th St, Box 0132, San Francisco, CA, 94143, USA
| | - Irena Tsui Irena
- Retina Division, Stein Eye Institute, University of California Los Angeles, 200 Stein Plaza, Los Angeles, CA, 90095, USA
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11
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The choroidal structure changes in a case with hypertensive choroidopathy. Am J Ophthalmol Case Rep 2020; 18:100710. [PMID: 32322755 PMCID: PMC7168347 DOI: 10.1016/j.ajoc.2020.100710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 03/31/2020] [Accepted: 04/09/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose The aim of this study is to report clinical course and provide novel ophthalmic findings by spectral-domain optical coherence tomography (SD-OCT) in a patient with hypertensive choroidopathy secondary to hypertensive disorders of pregnancy (HDP). Observations A 27-year-old woman, who was diagnosed HDP complicated with disseminated intravascular coagulation (DIC), noticed abnormality of color vision and metamorphopsia in her right eye, a half day after an emergency cesarean delivery. Fundus examinations showed developing serous retinal detachment (SRD) from superior hemisphere to the posterior pole in her right eye. Then, fluorescein angiography (FA) showed some granular leakages from the areas above the optic disc in her right eye and around the optic disc in her left eye. Indocyanine green angiography (IA) also showed choroidal hypoperfusion during the early-phase and choroidal hyperpermeability during the mid-phase in the same areas of leakages in FA. SD-OCT also showed posterior SRD in her right eye and peripapillary flat SRD in her left eye, and enhanced depth imaging OCT (EDI-OCT) revealed increased choroidal thickness. SRD gradually disappeared and her symptoms improved during observation with appropriate treatment for hypertension and resolution of DIC. Moreover, increased choroidal thickness in right eye improved in the only areas showing abnormal angiography findings, but subfoveal choroidal thickness in both eyes did not change over the clinical course. Conclusions Our case shows that hypertensive choroidopathy with developing SRD and visual disorder in the patient with HDP, can be improved by appropriate treatment for general state. Moreover, SD-OCT shows a new finding that increased choroidal thickness improved in the abnormal angiography areas earlier than SRD was completely disappeared. OCT may be a useful module to evaluate the changes in the choroidal structures for diagnosis and follow-up in a patient with hypertensive choroidopathy.
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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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