Park Young Joo, Park Kyu Hyung, Woo Se Joon
Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Korean J Ophthalmol. 2017 Aug;31(4):320-327. doi: 10.3341/kjo.2016.0080. Epub 2017 Jul 25.
To report clinical features of patients with retinal and choroidal diseases presenting with acute visual disturbance during pregnancy.
In this retrospective case series, patients who developed acute visual loss during pregnancy (including puerperium) and visited a tertiary hospital from July 2007 to June 2015, were recruited by searching electronic medical records. Patients were categorized according to the cause of visual loss. Clinical features and required diagnostic modalities were analyzed in the retinal and choroidal disease group.
Acute visual loss occurred in 147 patients; 49 (38.9%) were classified into the retinal and choroidal group. The diagnoses included central serous chorioretinopathy (22.4%), hypertensive retinopathy with or without pre-eclampsia (22.4%), retinal tear with or without retinal detachment (18.4%), diabetic retinopathy progression (10.2%), Vogt-Koyanagi-Harada disease (4.1%), retinal artery occlusion (4.1%), multiple evanescent white dot syndrome (4.1%), and others (14.3%). Visual symptoms first appeared at gestational age 25.9 ± 10.3 weeks. The initial best-corrected visual acuity (BCVA) was 0.27 ± 0.39 logarithm of the minimum angle of resolution (logMAR); the final BCVA after delivery improved to 0.13 ± 0.35 logMAR. Serious visual deterioration (BCVA worth than 20 / 200) developed in two patients. Differential diagnoses were established with characteristic fundus and spectral-domain optical coherence tomography findings in all cases.
In pregnant women with acute visual loss, retinal and choroidal diseases are common and could be vision threatening. Physicians should be aware of pregnancy-associated retinal and choroidal diseases and their clinical features. The differential diagnosis can be established with non-invasive techniques.
报告孕期出现急性视力障碍的视网膜和脉络膜疾病患者的临床特征。
在这个回顾性病例系列研究中，通过检索电子病历招募了2007年7月至2015年6月期间在孕期（包括产褥期）出现急性视力丧失并就诊于一家三级医院的患者。根据视力丧失的原因对患者进行分类。对视网膜和脉络膜疾病组的临床特征及所需的诊断方式进行分析。
147例患者出现急性视力丧失；49例（38.9%）被归入视网膜和脉络膜疾病组。诊断包括中心性浆液性脉络膜视网膜病变（22.4%）、伴有或不伴有先兆子痫的高血压性视网膜病变（22.4%）、伴有或不伴有视网膜脱离的视网膜裂孔（18.4%）、糖尿病性视网膜病变进展（10.2%）、伏格特-小柳-原田病（4.1%）、视网膜动脉阻塞（4.1%）、多发性一过性白点综合征（4.1%）以及其他（14.3%）。视觉症状首次出现于孕龄25.9±10.3周。初始最佳矫正视力（BCVA）为最小分辨角对数（logMAR）0.27±0.39；产后最终BCVA改善至0.13±0.35 logMAR。两名患者出现严重视力恶化（BCVA低于20/200）。所有病例均通过特征性眼底及光谱域光学相干断层扫描结果进行鉴别诊断。
在急性视力丧失的孕妇中，视网膜和脉络膜疾病很常见，且可能威胁视力。医生应了解与妊娠相关的视网膜和脉络膜疾病及其临床特征。可通过非侵入性技术进行鉴别诊断。
