Review of Ophthalmic and Breastfeeding Medicine Evidence

Dalal, Prarthana; Patel, Aloka L.; Carle, Michelle V; Rajanala, Alekya; Gill, Manjot K.

doi:10.1097/iae.0000000000002946

Cited by 7 publications

(4 citation statements)

References 28 publications

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“…Transfer of bevacizumab into breast milk and possible harm to the infant is possible, which requires further study and should always be considered. 8 In our case, the mother was no longer lactating. In lactating mothers, a suggested approach may be to temporarily avoid breastfeeding for the half-life duration of the intravitreal agent.…”

Section: Discussionmentioning

confidence: 57%

“…In lactating mothers, a suggested approach may be to temporarily avoid breastfeeding for the half-life duration of the intravitreal agent. 8 Key words: central retinal vein occlusion, pregnancy, macular edema, OCT, intravitreal steroid implant, intravitreal anti-VEGF.…”

Section: Discussionmentioning

confidence: 99%

“…In lactating mothers, a suggested approach may be to temporarily avoid breastfeeding for the half-life duration of the intravitreal agent. 8…”

Section: Discussionmentioning

confidence: 99%

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Central Retinal Vein Occlusion With Severe Macular Edema in Early Pregnancy

Pokroy¹,

Raskin²,

Masarwa³

2022

RETINAL Cases &Amp; Brief Reports

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To report the clinical course and treatment outcomes of a patient with central retinal vein occlusion with severe macular edema in early pregnancy.Methods: Interventional case report.Results: A 39-year-old woman with gestational diabetes mellitus and a 15-pack year smoking history presented at 7 weeks gestation with decreased vision due to central retinal vein occlusion with marked macular edema. One month later, visual acuity had decreased to 20/400, and macular edema had worsened to a central subfield thickness of 1,432 mm. She was treated with a single intravitreal dexamethasone implant at 16 weeks gestation. She responded well with visual acuity improving to 20/40+ and complete resolution of macular edema. At 33 weeks gestation, the cystoid macular edema recurred, but the patient refused treatment. The cystoid macular edema spontaneously resolved 3 weeks postpartum but recurred 3 months later with visual acuity worsening to 20/50. This macular edema resolved completely after a single 1.25 mg bevacizumab injection. She required no further treatment, and 23 months later, her macula was dry with visual acuity of 20/25. Her baby was healthy.Conclusion: Although pregnancy seems to aggravate central retinal vein occlusionassociated macular edema, the visual loss may be reversible. Intravitreal steroid seems to be effective during pregnancy with no apparent systemic or fetal complications. Young patients with retinal vein occlusion and center-involving macular edema may stabilize with minimal treatment.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

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Central Retinal Vein Occlusion With Severe Macular Edema in Early Pregnancy

Pokroy¹,

Raskin²,

Masarwa³

2022

RETINAL Cases &Amp; Brief Reports

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“…Data on breastfeeding in the context of anti-VEGF injections are also very limited [ 20 ]. Small pharmacokinetics studies suggest that intravitreal bevacizumab does not result in detectable drug levels in breast milk ( n = 2) [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Intravitreal anti-vascular endothelial growth factor injections in pregnancy and breastfeeding: a case series and systematic review of the literature

Ong,

Kiire,

Frise

et al. 2023

Eye

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Introduction Anti-vascular endothelial growth factor (anti-VEGF) agents may occasionally need to be considered for sight-threatening macular pathology in pregnant and breastfeeding women. This is controversial due to the dearth of data on systemic side effects for mother and child. We aimed to expand the evidence base to inform management. Methods Retrospective case series of pregnant and breastfeeding women treated with intravitreal anti-VEGF injections at Oxford Eye Hospital between January 2015 and December 2022. In addition, we conducted a systematic review and combined eligible cases in a narrative synthesis. Results We treated six pregnant women with anti-VEGF for diabetic macular oedema(DMO) (n = 5) or choroidal neovascularisation (CNV) (n = 1). Four received ranibizumab whilst two (not known to be pregnant) received aflibercept. Patients known to be pregnant underwent counselling by an obstetric physician. Five pregnancies resulted in live births. Combining our cases with those previously published, treatment of 41 pregnant women (42 pregnancies) are reported. Indications for treatment included CNV (n = 28/41,68%), DMO (n = 7/41,17%) and proliferative diabetic retinopathy (n = 6/41,15%). Bevacizumab (n = 22/41,54%) and ranibizumab (n = 17/41,41%) were given more frequently than aflibercept (n = 2/41,5%). Many (n = 16/41,40%) were unaware of their pregnancy when treated. Most pregnancies resulted in live births (n = 34/42,81%). First trimester miscarriages (n = 5/42,12%) and stillbirths (n = 3/42,7%) mostly occurred in women with significant risk factors. Conclusion Intravitreal anti-VEGF injections may not necessarily compromise obstetric outcomes, although clear associations cannot be drawn due to small numbers and confounders from high rates of first trimester miscarriages in general and inherently high-risk pregnancies. It may be worth considering routinely investigating pregnancy and breastfeeding status in women of childbearing age prior to each injection, as part of anti-VEGF treatment protocols.

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Anti-VEGF (anti-vascular endothelial growth factor) treatment for central vein occlusion during breastfeeding

et al. 2022

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Eine 40-jährige Mutter stellte sich mit akuter Visusminderung seit 2 h am rechten Auge vor. Am linken Auge war 2015 eine Prästase aufgetreten und eine Hyperlipoproteinämie A bekannt. Sie hatte vor 3 Wochen entbunden und stillte. Klinischer Befund Der Visus lag bei cc 0,05 rechts und 0,9 links. Die vorderen Augenabschnitte waren reizfrei. Am Fundus fand sich eine randunscharfe Papille rechts mit Streifenblutungen entlang der Gefäßbögen, gestauten Venen und flächenhaft Blutungen (. Abb. 1). Links fand sich ein Normalbefund. Therapie und Verlauf Die Patientin stellte sich wieder zur Nutzen-Risiko-Abwägung der IVT mit Anti-VEGF vor. Wir rieten mit dem Gynäkologen zu Ranibizumab (Lucentis ® , Novartis), die Patientin sollte weiter Stillen. Eine Die Ophthalmologie 1 Kasuistiken Abb. 2 8 Nahinfrarotaufnahme und SD-OCT rechtes Auge, Makulaödem und PMLM(blauer Pfeil). (Klinikum rechts der Isar) Abb. 3 8 Nahinfrarotaufnahme und SD-OCT rechtes Auge am 5. Tag nach 1. IVTmit Ranibizumab. (Klinikum rechts der Isar) Abb. 4 8 Nahinfrarotaufnahme und SD-OCT rechtes Auge 4 Wochen nach 1. IVTmit Ranibizumab. (Klinikum rechts der Isar)

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Review of Ophthalmic and Breastfeeding Medicine Evidence

Cited by 7 publications

References 28 publications

Central Retinal Vein Occlusion With Severe Macular Edema in Early Pregnancy

Central Retinal Vein Occlusion With Severe Macular Edema in Early Pregnancy

Intravitreal anti-vascular endothelial growth factor injections in pregnancy and breastfeeding: a case series and systematic review of the literature

Anti-VEGF (anti-vascular endothelial growth factor) treatment for central vein occlusion during breastfeeding

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