Managing Macular Issues in Pregnant Women with High Myopia

Q: Managing Macular Issues in Pregnant Women with High Myopia

Hello： <br>1. <br>Regarding the extent of retinal hemorrhage of approximately 2mm, it is considered a relatively small area; however, its location is more important than its size. <br>The closer it is to the fovea, the greater the impact. <br>Whether the hemorrhage in the macula

Macular issues in pregnant women?

Hello, doctor.
My wife has high myopia and experienced a sudden macular hemorrhage four days ago.
Fundus photography showed a hemorrhage area of about 2mm.
The initial doctor recommended an intravitreal injection to inhibit vascular endothelial growth factor, but since my wife is currently three and a half months pregnant, conservative treatment was suggested, and she was referred to a larger hospital.
After the referral, the doctor informed us that without immediate treatment, there could be a risk of permanent vision loss.
They recommended administering LUCENTIS (Ranibizumab), which may have a lesser impact on both the mother and fetus, but there is no guarantee of no effects, and we need to make our own decision.
An injection is scheduled in five days, and during this time, we plan to consult with the obstetrician and also seek advice from traditional Chinese medicine.

I would like to ask the doctor:
1.
Given the current extent of the hemorrhage, is the severity significant? (There has been no deterioration in vision over the past few days.) Is there a possibility of spontaneous absorption and recovery without scarring?
2.
Are there any successful cases in Taiwan of pregnant women using LUCENTIS and having normally developed babies? I found successful cases in foreign literature, but the sample sizes were too small to draw conclusions.

3.
Currently, at three and a half months pregnant, if aggressive treatment is done after delivery, is it possible to restore her original level of vision?
4.
Are there any other more appropriate approaches?
Thank you for your patience in reading these questions, and I appreciate your assistance in clarifying these concerns.
Thank you very much!

Xiang, 30~39 year old female. Ask Date: 2024/03/28

Dr. Gao Pilin reply Ophthalmology

Hello:
1.
Regarding the extent of retinal hemorrhage of approximately 2mm, it is considered a relatively small area; however, its location is more important than its size.
The closer it is to the fovea, the greater the impact.
Whether the hemorrhage in the macula has the potential for spontaneous absorption depends on the volume and location of the bleed.
Generally, smaller hemorrhages are more likely to absorb spontaneously.
However, even if the hemorrhage can absorb on its own, it may still leave scarring, which can affect vision.
2.
Concerning the use of LUCENTIS in pregnant women, there are indeed successful cases, but due to the limited number of experimental cases, there is insufficient evidence to demonstrate its effects on the fetus.
However, based on currently available data, the risk of LUCENTIS to the fetus appears to be low, but careful assessment and weighing of risks are still necessary.
3.
If you choose to pursue aggressive treatment after delivery, the likelihood of vision recovery will decrease.
This is because the longer the hemorrhage persists in the macula, the greater the damage to the retina.
Nevertheless, even if treatment is initiated after delivery, there is still a chance to improve vision.
Therefore, if you are concerned about the potential risks of LUCENTIS to the fetus, you may opt to delay treatment until after delivery.
4.
In addition to intravitreal injection of LUCENTIS, other treatment options include:
- Laser treatment: Laser therapy can be used to treat macular hemorrhage but may cause vision loss.
Therefore, it is typically used only when intravitreal injection of LUCENTIS is ineffective or unsuitable.

- Photodynamic therapy: Photodynamic therapy can also be used to treat macular hemorrhage but may lead to vision loss.
Thus, it is generally reserved for cases where intravitreal injection of LUCENTIS is ineffective or inappropriate.
Wishing your wife a speedy recovery.

Reply Date: 2024/03/28

More Info

Managing macular issues during pregnancy, especially in women with high myopia, is a complex and delicate situation that requires careful consideration of both maternal and fetal health. High myopia, defined as a refractive error greater than -6.00 diopters, is associated with an increased risk of retinal complications, including macular degeneration and retinal detachment. The situation is further complicated during pregnancy due to hormonal changes and increased blood volume, which can affect ocular health.

1. Severity of Macular Hemorrhage: The reported macular hemorrhage of approximately 2mm is concerning, but the severity can vary based on the individual’s overall eye health and the presence of other risk factors. In many cases, small hemorrhages can resolve on their own, especially if there is no significant deterioration in vision. The body has a remarkable ability to heal, and spontaneous absorption of the hemorrhage is possible. However, close monitoring is essential, as any changes in vision or symptoms should prompt immediate medical evaluation.

2. Use of LUCENTIS (Ranibizumab): LUCENTIS is an anti-VEGF (vascular endothelial growth factor) medication that is often used to treat macular edema and other retinal conditions. While there are limited studies on the use of LUCENTIS in pregnant women, some reports suggest that it may be safe, particularly in cases where the benefits outweigh the risks. There have been documented cases of pregnant women receiving LUCENTIS with normal fetal outcomes, but these are anecdotal and not extensive enough to draw definitive conclusions. It is crucial to have a thorough discussion with both the ophthalmologist and obstetrician to weigh the risks and benefits of this treatment.

3. Postpartum Treatment and Vision Recovery: If treatment is deferred until after delivery, there is a possibility of restoring vision, but this depends on the extent of the damage and the underlying cause of the hemorrhage. Early intervention is generally associated with better outcomes, so it is advisable to follow the recommendations of your healthcare providers closely. If the hemorrhage resolves on its own, vision may return to baseline, but if there are complications, further treatment may be necessary.

4. Alternative Approaches: In addition to LUCENTIS, other management strategies may include close observation, lifestyle modifications (such as reducing eye strain), and possibly the use of supplements that support eye health, such as omega-3 fatty acids. Consulting with a specialist in maternal-fetal medicine may provide additional insights into managing both the pregnancy and the ocular condition.

In conclusion, managing macular issues in pregnant women with high myopia requires a multidisciplinary approach. It is essential to maintain open communication with both the ophthalmologist and obstetrician to ensure that both maternal and fetal health are prioritized. Regular follow-ups and monitoring are critical to assess the progression of the condition and to make timely decisions regarding treatment. Always consider the potential risks and benefits of any intervention, and do not hesitate to seek a second opinion if needed.

Similar Q&A

Managing High Eye Pressure During Pregnancy: Key Considerations

Hello, Doctor: Due to high myopia around -9.00 diopters and corneal thickness of 550-560 micrometers, OCT and visual field examinations are normal. I have been regularly monitoring my eye pressure for nearly a year, which has ranged from 21 to 24 mmHg without using eye drops. Rec...

Dr. He Jianxian reply Ophthalmology
The safety of this medication for pregnant women has not yet been fully established. Therefore, if you are planning to become pregnant, it is recommended to avoid using this medication during pregnancy and breastfeeding, as advised by the OCT and visual field examinations. This i...

Do Eye Exams and Natural Birth Increase Retinal Risks for Pregnant Women?

Is it safe for a pregnant woman (who is seven months along) to use mydriatic agents for dilation and undergo a fundus examination? Additionally, does having high myopia (with both eyes exceeding -11.00 diopters) increase the risk of retinal detachment during the natural delivery ...

Dr. Ke Meilan reply Ophthalmology
Can a pregnant woman (who is seven months pregnant) use mydriatic agents for a fundus examination? Answer: Yes. If there is a concern about seeing less, the use of medication can be avoided. During the natural delivery process, does it increase the risk of retinal detachment? Ans...

Is Cesarean Delivery Safer for Patients with High Myopia?

Dear Dr. Chang: I once read a report in the newspaper stating that "patients with high myopia are at a higher risk of retinal detachment if they undergo vaginal delivery." I currently have a myopia of -8.50 diopters in both eyes and am six months pregnant. I am wonderin...

Dr. Zhang Yanrui reply Ophthalmology
Labor requires increased abdominal pressure, which theoretically could have an adverse effect on the occurrence of retinal detachment. However, current scientific research has not found a correlation between the two. Therefore, given your condition, if there is any degeneration o...

Managing High Myopia: Concerns About Vision Loss and Treatment Options

Dear Doctor, I am 30 years old and have a girlfriend with whom I am considering marriage. However, I have been troubled by my eye issues for a long time, even contemplating whether I should get married, as I worry about the possibility of becoming blind in the future. I have hig...

Dr. Zhang Zhengzhong reply Ophthalmology
Hello Jason, 1. The symptoms of retinal detachment include the presence of fixed shadows. If you experience this, please seek medical attention promptly. Additionally, if you notice symptoms resembling rain in your vision, it may indicate warning signs from the retina, and you s...