Search

This article reviews the critical issue of diabetic retinopathy (DR) in pregnant women with diabetes mellitus (DM), and describes the current understanding of the features of DM progression during pregnancy, as well as its pathogenic mechanisms, risk factors, and preventive measures for manifestation and progression of DR during gestation.

Purpose: This study aimed to identify factors associated with the development of myopic maculopathy (MM) in patients with acquired myopia., Material and Methods: The study included a total of 135 patients (41 men, 94 women; 135 eyes) over 30 years old with acquired myopia and axial length (AL) of 26 mm. Forty-six patients had MM, while 89 (66%) had no macular changes. Optical coherence tomography angiography (OCT-A) and B-scan ultrasound of the eyes were performed to detect staphylomas of the posterior pole sclera. OCT was used to assess corneal stromal thickness and choroidal thickness. Corneal biomechanics were measured using the Corvis ST device, and ocular vessel hemodynamics were evaluated using color Doppler imaging. Binary logistic regression was employed, with a multivariable logistic model built for each of these potential risk factors, adjusted for sex, age, AL, and spherical equivalent (SE)., Results: Age, AL, SE, and extra-macular myopic changes were significantly associated with the presence of MM. Of the seven qualitative risk factors studied, the presence of extra-macular changes, staphyloma, and wide macular staphyloma localization were statistically significant. Among the quantitative factors, significant associations were found with the width and depth of staphyloma, the area of the ultrasound cross-section of staphyloma (W×D), choroidal thickness in all examined zones, all corneal stromal thickness parameters, corneal deformation amplitude (DA), curvature radius highest concavity (radius HC), and corneal peak distance (PD)., Conclusion: The statistically significant risk factors associated with MM were age, AL, SE, the presence and size of staphylomas, choroidal and corneal stromal thickness, as well as several parameters characterizing corneal biomechanical properties. The strongest associations with MM were found for corneal PD, staphyloma depth, and choroidal thickness in the nasal perifovea.

Purpose: The study evaluates the transient and stationary diabetic retinal changes in pregnant women with diabetes mellitus (DM) based on the analysis of individual clinical cases of diabetic retinopathy (DR) progression., Material and Methods: The study examined 24 pregnant women with DM. The examination was carried out in each trimester of pregnancy and 6 months after delivery. In 10 pregnant women DR was not detected, and 14 (58%) were diagnosed with DR., Results: Progression of DR during pregnancy was observed in 9 patients with pre-proliferative and proliferative DR (PPDR and PDR) and uncompensated glycemia, 3 patients developed macular edema (ME) in both eyes. Panretinal laser coagulation (PRLC) was performed in patients with ongoing DR progression. In the postpartum period, the manifestations of DR did not regress. ME turned out to be transient in one patient with PPDR. Three clinical cases of DR manifesting in the first trimester of pregnancy are presented: PPDR with transient ME, PDR with ME, non-proliferative DR with a stable course., Conclusion: 1. DR detected at the beginning of gestation in women with decompensated glycemic status progressed in 64% of cases. 2. Progression of DR during pregnancy was noted in patients with PPDR and PDR. 3. Progression of DR during pregnancy is more often true than transient. 4. Detection of PPDR and PDR during pregnancy is a direct indication for laser coagulation of the retina.

Complicated myopia develops in young people of working age, of which about 30% subsequently become visually impaired. Formation of ocular staphyloma affects the macula causing myopic maculopathy, which leads to significant and irreversible decrease in visual functions., Purpose: To study the occurrence frequency of various forms of myopic maculopathy in scleral staphylomas of different localization in patients with pathologic myopia., Material and Methods: The study included 105 patients with high myopia (105 eyes, axial length ≥26 mm). The main group consisted of 50 patients with myopic scleral staphylomas (50 eyes). The comparison group - 55 patients (55 eyes) without scleral staphylomas., Results: In the main group, myopic maculopathy was detected in 82% of eyes, it was absent in 96% of eyes in the comparison group. In the main group there were: staphyloma of the posterior pole of the eye with involvement of the optic nerve head (ONH) - 44% of eyes; macular staphyloma - 28% of eyes; peripapillary staphyloma - 12% of eyes; staphyloma below the ONH - 16% of eyes. Atrophic, neovascular and traction maculopathy was revealed in 22 eyes with staphylomas of the posterior pole of the eye. Dome-shaped changes in the macula were revealed in 17 patients (19 eyes) of the main group (15 eyes with staphylomas of the posterior pole of the eye, 4 eyes with macular staphylomas). The highest average value of axial length (30.94±0.81 mm) was noted in eyes with macular staphylomas, and the lowest (28.58±1.62 mm) - with staphylomas near the ONH., Conclusion: The presence of myopic maculopathy is associated with the presence of staphylomas with the odds ratio of 120.7 (95%, confidence interval 24.7-589.3). Staphyloma of the posterior pole of the eye and macular staphyloma were associated with the most severe forms of myopic maculopathy and low visual acuity.

Studying the condition of retinal blood flow in pregnant women with disorders of carbohydrate metabolism contributes to early detection of diabetic retinopathy (DR), which is necessary for timely treatment and preservation of high visual functions., Purpose: To study retinal blood flow in pregnant women with disorders of carbohydrate metabolism using optical coherence tomography angiography (OCTA) in order to determine the criteria for manifestation and progression of DR., Material and Methods: The study examined 203 pregnant women in the third trimester: 24 - with type 1 and 2 diabetes (T1D and T2D), 143 - with gestational diabetes (GD), and 36 apparently healthy women with physiological pregnancy that comprised the control group. OCTA imaging was performed on RTVue XR Avanti ("Optovue", USA) system using HD Angio Retina 6.0 mm 2 scan protocol. The whole image vessel density (wiVD), foveal vessel density (FVD), and foveal avascular zone (FAZ) area in the superficial capillary plexus were studied., Results: FVD was significantly lower in pregnant women with diabetes than in pregnant women with GD and in the control group, prompting an assumption that retinal microvascular regulation changes because of chronic disturbances of carbohydrate metabolism in such patients and due to development of microangiopathy. Statistically significant increase in FAZ area and decrease in wiVD were revealed in patients with DR compared to data from the group of pregnant women with diabetes but without DR, in the absence of differences in FVD. In 2 patients with T1D and no ophthalmoscopic signs of DR, OCTA revealed areas of nonperfusion in the posterior pole of the eye., Conclusion: OCTA can help identify areas of retinal nonperfusion in the posterior pole of the eye in pregnant women with diabetes and no ophthalmoscopic signs of DR, and determine objective indications for timely retinal laser coagulation.

In recent years, much attention is being paid to studying the state of the choroid in various eye pathologies, but changes in the choroid of pregnant women with disorders of glucose metabolism remain unexplored., Purpose: To study choroidal thickness in pregnant women with disorders of carbohydrate metabolism in the III trimester., Material and Methods: The study included 376 pregnant women in the third trimester of pregnancy: 49 of them had type 1 diabetes (T1D), 248 had gestational diabetes (GD), and 79 were healthy pregnant women who comprised the control group. Three subgroups were distinguished among patients with GD, depending on the timing of the development of GD in the I (160 patients), II (56 patients), or III (32 patients) trimesters. Optical coherence tomography was performed to measure choroidal thickness in the foveal region., Results: In patients with GD, no significant differences in average indexes of choroidal thickness in subgroups with different timing of diabetes development were observed, however, the pregnant women of the GD subgroup with beginning of its development in the first trimester had the smallest indexes of average choroidal thickness. In pregnant women with GD who received insulin, choroidal thickness was lower than in patients who did not receive it, although statistical significance of that was not established. In patients with T1D and diabetic retinopathy (DR), choroidal thickness was significantly lower compared to patients with T1D without DR, GD and control groups. Obtained data indicates the presence of changes in the choroid and development of diabetic choroidopathy in pregnant women with T1D and DR., Conclusion: The study of choroidal changes in pregnant women with disorders of carbohydrate metabolism can help identify criteria for manifestation of diabetic microangiopathy, choroidopathy, and predict the progression of DR.

Introduction: Pregnancy is a risk factor for progression of diabetic retinopathy (DR). Despite the common opinion about the regression of DR after childbirth, it is possible for the disease to progress aggressively, which can cause loss of visual functions when treated untimely., Purpose: To present clinical cases with different course of development of DR in pregnant women with type 1 diabetes mellitus (DM1)., Material and Methods: Five pregnant women with DM1 lasting more than 8 years were examined. Glycemic level of all patients was higher than normal (glycated hemoglobin (HbA1c) of more than 6.1%). Ophthalmologic examination was carried out including fundus photography, optical coherence tomography (OCT) of the macular area, Angio-OCT., Results: The most significant factors in the progression of DR in pregnant women are DR1 compensation, severity and stabilization of DR during the preconception period, presence of a concomitant pathology. Timely detection of signs of progression of DR and therapeutic measures taken during pregnancy, in particular laser coagulation, were shown to stabilize the course of the disease and prevent loss of vision in pregnant women with DM1., Conclusion: Clinical course of DR in pregnancy can vary between absence of manifestation, stabilization, and progression. Progression of DR during pregnancy is determined by a number of factors including compensation of DM during the preconception period and throughout pregnancy, severity and stabilization of retinopathy during the preconception period, and presence of a concomitant pathology. Timely detection of the signs of DR progression and its treatment, in particular laser coagulation of the retina, can help stabilize the course of the disease during pregnancy. The course of DR may be aggressive in some pregnant women involving progression in the postpartum period, which warrants active monitoring of patients with retinopathy after childbirth.

Information about relationship between biochemical indexes of endothelial dysfunction in preeclampsia and morphometric parameters of macula is necessary for prediction of the risk of retinal vascular disorders., Purpose: To study the relationship between biochemical indexes of blood serum, lacrimal fluid (LF) and the macular retinal volume (MRV) in pregnant women with preeclampsia., Material and Methods: The study included 42 pregnant women aged 21 to 40 years with preeclampsia of different severity (the main group): 1st subgroup - mild degree (22 people); 2nd subgroup - average degree (12 people); 3rd subgroup - severe degree (8 people). The comparison group included 20 pregnant women aged 19 to 38 years experiencing physiologically natural pregnancy., Results: By the 3rd trimester, in the 1st subgroup the index of MRV was between 6.4 and 9.5 mm 3 ; the index of von Willebrand factor (vWF) - 88.9±7.3%; endothelin (ET) content in LF was 1.35±0.2 ng/ml; the indices of free radical oxidation (FRO) in lacrimal fluid (Ssp and Sind) were significantly higher than in the comparison group (p<0.01). In the 2nd subgroup: MRV was 7.4±0.5 mm 3 , ET - 2.2±0.3 ng/ml, and vWF - 117.2±8.5% (p<0.01); the indices of FRO were higher in comparison with the 1st subgroup. In the 3rd subgroup: MRV was 8.5±0.7 mm 3 , ET - 3.2±0.3 ng/ml, and vWF - 157±9.5% (difference with the 2nd subgroup p<0.01). The indices of FRO (Ssp, Sind and h) indices were maximum high (difference with the 2nd subgroup p<0.01)., Conclusion: A trend of increase of MRV by the 3rd trimester correlating with the degrees of preeclampsia severity was found. In the main group (r from 0.71 to 0.83), strong, direct, statistically significant association was found between the increase of ET levels in LF, vWF and MRV on the one side, and FRO on the other side.

The paper presents an atypical case of solar retinopathy after short-term exposure to reflected focused sunbeams. An ophthalmoscopic peculiarity was the presence of intraretinal hemorrhage. The basis for establishing the diagnosis were spectral optical coherence tomography and fluorescein angiography findings.