1. The influence of pregnancy changes on myopic patients’ eyes
S. Kwiecień, M. Pawluczyk - Dyjecińska, A. Sokołowska - Oracz, J.Szaflik
Department of Ophthalmology, Medical University of Warsaw, Poland
Ophtalmology Outpatient Clinic of Hospital Gynecology and Maternity "Livonian"

2. The aims of our study were to establish ocular indications to:
Indications to type of delivery can be difficult in case of high myopic patients or with degenerations of peripheral retina. Intraocular pressure changes and Valsalva mechanism can have influence on retinal tears and retinal detachment appearing.
The aims of our study were to establish ocular indications to:
type of delivery,
laser photocoagulation,
The aim of our study was also to find any ocular changes which occur during pregnancy.

3. Material 102 eyes - 51 patients (age: 24 – 39, mean 30,5) 21 – 40 Hbd, mean 33 Hbd
Method
Orbscan, USG, OCT and a complete ophthalmologic examination were performed during pregnancy and min 6 months after delivery. Laser treatment was performed in vitreo-retinal traction and tears presence:
I examination: 2 days – 16 weeks before delivery
mean 7 weaks
II examination: 1 – 19 months after delivery
mean 9,5 months

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5. Refraction Intracular pression Increase of myopia 0,75 – 1,5 dsph
Stabilisation
-0,5 → +0,5 dsph
Decrease of myopia
0,75 – 1,0 dsph
Total
34,6%
47,4%
18%
patients’ -observation span - from 9 to19 months
21,8%
67,2%
11%
Intracular pression
Increase after delivery
1 – 6 mmHg
stabilisation
Decrease after delivery
1 – 4 mmHg
46,7%
23,3%
30%

6. Macular thickness- OCT
Pachymetry
Decrease after delivery
6 – 51 μm
Stabilisation -5 → +5 μm
Increase after delivery
6 – 8 μm
83,8%
1,5%
14,7%
Macular thickness- OCT
Increase of macular thickness after delivery μm
Mean 9 μm
73 %
Decrease of macular thickness after delivery μm
Mean 11 μm
27 %

7. Biometry Lenght of the eye globe Below 26 mm Above 26 mm
78,2%
21,8%
Decrease of the globe’s length
0,1 – 0,25 mm
Increase of the globe’s length0,1 – 0,17 mm
Stabilisation
73%
26% 1%

8. Vitreous attachment - results
I exam
initial PVD
I exam total PVD
I exam vitreous attachment
II exam initial PVD
II exam total PVD
II exam vitreous attachment
Total
58,7%
27%
14,3%
46,5%
39,6%
13,8%
Spontaneous delivery
50%
27,3%
22,7%
36,4%
13,6%
Delivery by Caesarean section
56,2%
31,2%
12,6%
37,5%
12,5%
Instrumental delivery
2 patients
100% 0%

9. Eyes after laser Peripheral retinal degenerations Total
the globe’s length ↑ 26mmHg
Szroniaste
42,2%
80%
Normal retina
40,8% 5%
Retinal tears 6% -
Lattice 4%
15%
Pigment aggregation
Retinoschisis 3%
Eyes after laser
yes no
Total
38,4%
61,6%
the globe’s length ↑ 26mmHg
57,1%
42,9%

10. Vitreous attachment after laser treatment time to delivery :
3 days – 4 months / mean 6 weeks
Total
↑ 26mmHg
Without changes
80%
31,3%
Total PVD 5%
43,7%
Initial PVD
15%
25%

11. Results Refraction changes 52,6% (↑-34,6%;↓-18%),
Persistent increase of myopia after delivery 21,8%
Decrease of intraocular pressure during pregnanacy
Increase of pachymery during pregnancy 83,8%
Slight decrease of the globe’s length 76%
Slight influence of laser on PVD generating
PVD after delivery SN – 45,4%, CC- 37,6%

12. Indications for laser treatment
Peripheral retinal degenerations with vitreoretinal tractions
Retinal tears and holes
because of PVD appearance, laser treatment before delivery is indicated
laser treatment can be performed at any time during pregnancy

13. Qualification for type of delivery
Spontaneous delivery even after laser treatment
Cesarean section:
Acute PVD with retinal tears and vitreous hemarrage
Retinal detachment after operation up to 1 year before delivery
Active subretinal neovascularisation - Fostera-Fuchsa ?
Advanced glaucoma with scant visual field ?