Published online Sep 15, 2021. doi: 10.4239/wjd.v12.i9.1386
Peer-review started: January 25, 2021
First decision: June 16, 2021
Revised: June 25, 2021
Accepted: August 12, 2021
Article in press: August 12, 2021
Published online: September 15, 2021
Diabetes mellitus (DM) is a noncommunicable disease reaching epidemic proportions around the world. It affects younger individuals, including women of childbearing age. Diabetes can cause diabetic retinopathy (DR), which is potentially sight threatening when severe nonproliferative DR (NPDR), proliferative DR (PDR), or sight-threatening diabetic macular oedema (STDME) develops. Pregnancy is an independent risk factor for the progression of DR. Baseline DR at the onset of pregnancy is an important indicator of progression, with up to 10% of women with baseline NPDR progressing to PDR. Progression to sight-threatening DR (STDR) during pregnancy causes distress to the patient and often necessitates ocular treatment, which may have a systemic effect. Management includes prepregnancy counselling and, when possible, conventional treatment prior to pregnancy. During pregnancy, closer follow-up is required for those with a long duration of DM, poor baseline control of blood sugar and blood pressure, and worse DR, as these are risk factors for progression to STDR. Conventional treatment with anti-vascular endothelial growth factor agents for STDME can potentially lead to foetal loss. Treatment with laser photocoagulation may be preferred, and surgery under general anaesthesia should be avoided. This review provides a management plan for STDR from the perspective of practising ophthalmologists. A review of strategies for maintaining the eyesight of diabetic women with STDR with emphasis on prepregnancy counselling and planning, monitoring and safe treatment during pregnancy, and management of complications is presented.
Core Tip: Progression of diabetic retinopathy (DR) to the sight-threatening DR (STDR) is rare during pregnancy but can cause significant ocular morbidity and distress to the mother. Good prepregnancy and intrapartum control of systemic risk factors, especially blood sugar and blood pressure, and adequate prepregnancy treatment of STDR will reduce complications during pregnancy. When STDR develops, conventional therapy for nonpregnant individuals may not be applied. This includes avoidance of anti-vascular endothelial growth factor agents conventionally for diabetic macular oedema and proliferative DR (PDR), especially during early trimesters. Panretinal photocoagulation is a safe option for PDR. Surgical treatments should be performed under local anaesthesia or preferentially deferred until postpartum.