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Observational Study
. 2023 Jul;71(7):2784-2788.
doi: 10.4103/IJO.IJO_3169_22.

Epidemic retinitis during pregnancy

Ankush Kawali  1 , Padmamalini Mahendradas  1 , Srinivasan Sanjay  1 , Sai Bhakti Mishra  1 , Bhujang Shetty  2
Affiliations
Observational Study

Epidemic retinitis during pregnancy

Ankush Kawali et al. Indian J Ophthalmol. 2023 Jul.

Abstract

Purpose: To study the clinical presentation and treatment outcome of epidemic retinitis (ER) during pregnancy.

Methods: This is a retrospective, observational chart review of pregnant patients diagnosed with ER from January 2014 to February 2023. Demographic details, month of pregnancy at the onset of ocular symptoms, history of present illness, clinical manifestations, and treatment outcomes were studied.

Results: In 9 years, ER was seen in 86 females, of whom 12 (13.9%) were pregnant. Twenty-one eyes of those 12 patients were studied. Most of the patients presented in the sixth month of pregnancy (range: 5-9 months, mean: 6.3 months). Physicians diagnosed viral exanthematous fever in six, typhoid in three, and suspected rickettsia in one patient. Medical termination of pregnancy (MTP) was performed in two patients before presentation. Weil-Felix test was positive in five, Brucella in one, WIDAL in three, and coronavirus disease 2019 (COVID-19) IgG and dengue IgG in one patient each. Oral antibiotics were given in five patients (two post-medical termination of pregnancy [MTP]) for the retinitis. All except four received oral steroids. Mean presenting corrected distant visual acuity (n = 21) was 20/125 (range: 20/20-20/20,000), which improved to (n = 18) 20/30 (range: 20/20-20/240). Macular edema (n = 11) resolved in 33.18 days (range: 20-50 days), and retinitis (n = 13) resolved in 58 days (range: 30-110 days). Ocular and systemic examination of newborn was possible in two and the babies were normal.

Conclusion: ER is seen commonly at the beginning of the third trimester. Lack of antibiotics may delay the resolution of retinitis. Ocular health needs to be assessed in larger series to conclude absence of retinal involvement in newborns.

Keywords: Antibiotics; epidemic retinitis; post-fever retinitis; pregnancy; treatment.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Fundus photo of both the eyes (case 13) shows cotton-wool spot-like retinitis lesions along the inferior arcade (a) and around the disc inferiorly with macular star formation (b). OCT scan passing through the retinitis lesions shows inner retinal hyperreflectivity with back shadowing, edema in the outer nuclear layer with subretinal fluid in the right (c) and (d) left eyes, suggestive of epidemic retinitis. OCT = optical coherence tomography
See this image and copyright information in PMC

References

    1. Kawali A, Srinivasan S, Mahendradas P, Shetty B. Epidemic retinitis and community outbreaks. Indian J Ophthalmol. 2020;68:1916–9. - PMC - PubMed
    1. Sundar DM, Chawla R, Balaji A, Garg I, Kalathil R, Hasan N, et al. Clinical features, optical coherence tomography findings and treatment outcomes of post fever retinitis. Ther Adv Ophthalmol. 2020;18:2515841420979111. - PMC - PubMed
    1. Shenoy P, Kohli GM, Kerketta A, Pathak P, Shetty S, Barde P, et al. Clinical profile and response to steroids in post-fever retinitis: A nine-year experience from a referral institute in the rural hinterland of Central India. Int Ophthalmol. 2021;41:4055–63. - PubMed
    1. Kawali A, Sanjay S, Mahendradas P, Shetty B. Response to ‘Clinical features, optical coherence tomography findings and treatment outcomes of post-fever retinitis’. Ther Adv Ophthalmol. 2021;13:2515841421992230. - PMC - PubMed
    1. Kawali A, Srinivasan S, Mohan A, Bavaharan B, Mahendradas P, Shetty B. Epidemic Retinitis with Macular Edema -Treatment Outcome with and without Steroids. Ocul Immunol Inflamm. 2021;29:932–6. - PubMed

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