Management of Retinal Diseases in Pregnant Patients

Abstract

Pregnancy leads to significant changes in the body, which potentially affect the retina. Pregnancy can induce disease, such as that seen in hypertensive retinopathy and choroidopathy. It can cause exudative retinal detachments in the HELLP syndrome (hemolysis, elevated liver enzymes and low platelets), disseminated intravascular coagulation (DIC), and thrombotic thrombocytopenic purpura (TTP), and provoke arterial and venous retinal occlusive disease. Pregnancy may also exacerbate pre-existing retinal disease, such as idiopathic central serous chorioretinopathy (ICSC) and diabetic retinopathy. Special consideration needs to be exercised when treating pregnant patients in choosing medications, as well as in selecting diagnostic modalities and surgical methods.

Keywords: Exudative Retinal Detachment; Pregnancy; Retina.

Figure 1

Color fundus photograph of a patient with pregnancy-induced hypertension. Findings include arteriolar constriction, retinal hemorrhages, cotton-wool spots and lipid exudates.

Figure 2

Images of the right eye of a 34-year-old woman with reduced vision since pregnancy complicated by pre-eclampsia and renal failure 10 months earlier. Multifocal, discrete areas of atrophy involving the outer retina, retinal pigment epithelium and inner choroid are seen in the color photograph (a), fundus autofluoresence image (b), and optical coherence tomography (OCT) image (c). (Images courtesy of David N. Zacks, MD, PhD).

Figure 3

Fundus photograph of the left eye of a patient with severe bilateral vision loss occurring immediately after childbirth. There are multiple, large, near-confluent patches of ischemic retinal whitening involving the posterior retina.

Figure 4

Fundus photograph (top) and OCT image (second row) of the right eye of a pregnant woman in the late second trimester with progressive subretinal fibrin deposition and VA of 20/60. The white arrow indicates the presumed location of the responsible leak, which was treated with mild-intensity laser photocoagulation. Five months after treatment, there is complete resolution of subretinal fluid and fibrin by fundus photography (third row) and OCT imaging (fourth row).