Management of uveitic and chorioretinal conditions in pregnancy.
Ong Ariel Yuhan, Christou Evita Evangelia, Kiire Christine A, Primrose Naomi, Tucker William R, Frise Charlotte, de Silva Samantha R
AI Summary
This review addressed managing sight-threatening chorioretinal conditions in pregnancy. It found evidence supporting various treatments, including steroids and anti-VEGFs, balancing maternal vision with fetal safety, and clarifying delivery misconceptions.
Abstract
During pregnancy, women may develop de novo sight-threatening chorioretinal diseases or experience exacerbations of these conditions. Examples include macular neovascularisation, diabetic macular oedema, and posterior uveitis. Ophthalmologists may not necessarily recommend the standard treatment for these disorders when they arise in pregnant women due to a lack of evidence regarding safety and potential risks of teratogenicity and fetotoxicity, and a lack of experience with managing this patient population. However, withholding treatment may lead to irreversible maternal vision loss. In this review, we discuss therapies that may need to be considered in these conditions, including steroids, intraocular pressure-lowering treatment for steroid-induced glaucoma, systemic immunosuppressants, and intravitreal anti-vascular endothelial growth factor agents. We discuss the evidence base behind these treatments in terms of safety in pregnancy, bringing in the obstetric perspective. We also discuss common misconceptions surrounding different modes of delivery in pregnant women with chorioretinal disease.
MeSH Terms
Shields Classification
Key Concepts3
Ophthalmologists may not necessarily recommend standard treatments for sight-threatening chorioretinal diseases like macular neovascularisation, diabetic macular oedema, and posterior uveitis in pregnant women due to lack of evidence regarding safety, potential risks of teratogenicity and fetotoxicity, and limited experience with this patient population.
Withholding treatment for sight-threatening chorioretinal diseases in pregnant women may lead to irreversible maternal vision loss.
Therapies considered for uveitic and chorioretinal conditions in pregnancy include steroids, intraocular pressure-lowering treatment for steroid-induced glaucoma, systemic immunosuppressants, and intravitreal anti-vascular endothelial growth factor agents.
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