This review examines the evolution of views and opinions on issues related to the management of pregnancy and childbirth in women with high myopia. Special attention is given to the threat of retinal detachment and its prevention during pregnancy and delivery; the need for improving the diagnosis of retinal abnormalities is also addressed. Our analysis indicates that since the early 1980s, pregnancy associated peripheral vitreochorioretinal dystrophy was considered a leading risk factor for rhegmatogenous retinal detachment during childbirth. Here, we present data on the eye hemodynamics and intraocular pressure in women at the time of delivery. We also discuss current strategies of pregnancy management in women with peripheral vitreochorioretinal dystrophy. In addition, absolute and relative indications for natural delivery in women with high myopia are presented together with ophthalmological requirements for natural delivery.
Aim. To investigate the incidence and structure of vascular retinal pathologies in women with preeclampsia and its combination with chronic arterial hypertension (AH).Methods. A total of 231 medical records of women with different pregnancy histories were studied by consecutive sampling. The first experimental group comprised women (n = 47) diagnosed with preeclampsia combined with chronic AH. The second experimental group comprised women (n = 48) with preeclampsia developed during pregnancy. The first comparison group included women with pregnancy-associated gestational AH. The second comparison group included women with edema and proteinuria during pregnancy but without AH. The control group consisted of women (n = 50) with normal pregnancy histories. The postpartum period ranged from 6 to 12 years.Results. The development of vascular retinal pathologies during the postpartum period occurred in 28 women in the general sample (12%). Retinal vein occlusions predominated in the structure of vascular retinal pathology (19 women, 19 eyes). Proliferative retinopathy was detected in 8 patients (8 eyes). In one case, a central retinal artery occlusion developed.Conclusions. The incidence of vascular retinal pathologies in the 1st and 2nd experimental groups comprised 21% and 25% respectively, which was statistically significantly higher than that in the control, 1st and 2nd comparison groups (4%, 4%, and 6% respectively, p < 0.01). The revealed significantly higher incidence of vascular retinal pathology in both experimental groups indicates the domineering role of preeclampsia and AH-associated pre-eclampsia in the development of vascular retinal pathologies.
Purpose. To study the morphometric features of macular edema in occlusions of the retinal veins, to determine and systematize the conditional gradations of the degrees of its severity.Patients and methods. 67 patients (67 eyes) were recruited using a continuous sampling method. Their age ranged from 38 to 84 years (on average 60.0 ± 10.5 years). Among them there were 27 men and 41 women. In 19 patients, there was an occlusion of the central retinal vein (28 %), in 48 people — occlusion of its branches (72 %). The lesions of the superior temporal branch prevailed — 32 people (65 %), 16 patients had occlusion of the inferior temporal branch (35 %). Systematization of the obtained data was carried out with the allocation of morphometric gradations of the severity of macular edema against the background of retinal vein occlusions.Results. According to our data, the morphometric parameters of the macular retina in the presence of macular edema were characterized by a wide range of gradations in the thickness of the foveal retina and the volume of the macular retina (from 239 to 861 μm and from 10,4 to 17,4 mm3 respectively).The morphological features of macular edema in retinal vein occlusions are the formation of cystic cavities in the outer and inner layers of the retina, convex deformation of the retinal profile, and the development of neuroepithelial detachment in 21 % of cases. Taking into account the data obtained, we proposed a conditional morphometric classification of the severity of macular edema in retinal vein occlusions. A mild degree of macular edema was characterized by values of the foveal retinal thickness index up to 400 μm; for medium — from 401 to 600 microns; for severe macular edema — over 600 microns. In accordance with our own conditional clinical morphometric classification of the severity of macular edema, mild macular edema was determined in 32 %, medium degree — in 43 %, severe — in 25 % of patients’ eyes.Conclusion. The identification of various clinical and morphometric degrees of severity of macular edema, in our opinion, is of practical importance, since it will allow more optimal and objective selection of the most optimal treatment tactics, taking into account the individual morphometric characteristics of the patient’s macular region.
Objective: Clinical assessment of chorioretinal hemodynamics in women at risk for vascular retinal pathology before and after long-term courses of preventive care.Methods: 60 women having undergone preeclampsia during pregnancy were exam‑ ined. The 1st group of patients (30 people) got courses of medicamentous correction of endothelial dysfunction: sulodexide, ginkgo biloba (Tanakan), ascorbic acid. The 2nd group (30 women) did not get preventive care. The control group included 30 women having undergone physiological pregnancy (vaginal delivery, without complications). Parameters of chorioretinal hemodynamics were determined 6–8 months later and 3–4.5 years later after delivery.Results: By the end of the follow-up, in the 1st group, the blood flow velocity in the posterior short ciliary arteries statistically significantly increased; the density of the retinal vessels and subfoveolar thickness of the choroid and the area of the avascular zone of the retina decreased.Conclusions: The long-term medicamentous correction of endothelial dysfunction reduces the risk of vascular pathology development in women having undergone preeclampsia during the pregnancy.
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