Diabetic retinopathy, proliferative retinopathy and exudative retinal detachment
Physiological changes that occur during the gestational period, such as increased blood pressure and serum cortisol levels, hyper-coagulability of the blood and transient conditions of insulin resistance, may favour the occurrence of certain eye diseases, such as hypertensive retinopathy or diabetic retinopathy (DR), the latter especially in the presence of diabetes.
In particular, some research groups, including the Diabetes Control and Complications Trial Research Grouphave shown that the progression of RD takes place with double the speed in pregnant women.
According to Industry Specialists, risk factors implicated in this rapid progression of DR in pregnant and diabetic women could be, in addition to the presence of pre-pregnancy DR:
- the duration of diabetes;
- hypertension;
- nephropathy.
Therefore, experts suggest that women with diabetes and seeking a pregnancy should maximising glycaemic control both before conception and throughout the first trimester, a preventive action aimed at both the management of diabetic pathology per sebut also to the reduced risk of faster progression of DR.
For patients, on the other hand, subject to a mild non-proliferative retinopathyexaminations to the eye should be carried out every 3/6 months; while for women presenting a severe non-proliferative retinopathyit would be advisable to undergo a full eye evaluation every month for 3 months and for a period of at least one year after giving birth.
Moreover, recent studies have shown that in pregnant patients the HELLP syndrome (Hhaemolysis, Elevated Liver enzymes, Low Platelets), a complex condition characterised by haemolysis, elevated liver enzyme levels and reduced platelet count, could be associated with a bilateral exudative retinal detachment and vitreous haemorrhage.
Thus, it is clear that pregnant women, especially those with diseases concomitant to the gestational period, must not underestimate the importance of a proper eye and vision screening and control programme in order to reduce the risk of certain eye diseases, even serious ones.
Bibliography
- Diabetes Care 2017. http://care.diabetesjournals.org/content/40/Supplement_1
- How to manage retinal disease in pregnant patients. Modern Retina- from Ophthalmology Times. http://modernretina.modernmedicine.com/modern-retina/news/how-manage-retinal-disease-pregnant-patients?page=0,0
- The Diabetes Control and Complications Trial Research Group. Diabetes Care (2000) 23(8): 1084-1091.
Dr. Carmelo Chines
Direttore responsabile
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