IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5 - Negrar, 37024, Verona, Italy.
BMC Ophthalmol. 2020 Dec 9;20(1):483. doi: 10.1186/s12886-020-01759-5.
Choroidal neovascularization (CNV) in pregnancy has rarely been described. A differential diagnosis between inflammatory, idiopathic, and myopic CNV may be challenging. Moreover, there is no consensus on management, and therapeutic options may be further limited by patient and physician concerns about potential risk to the fetus. Herein, we report a case of inflammatory CNV during pregnancy and describe a previously unreported management approach with retrobulbar triamcinolone injections.
A 36-year-old woman presented with vision loss and metamorphopsia in her right eye while 21 weeks pregnant. She was diagnosed with an inflammatory CNV based on the following multimodal imaging findings: a type 2 lesion with the "pitchfork sign" on OCT, along with the absence of tomographic signs of myopic CNV, and the presence on autofluorescence of multiple hyper-autofluorescent spots, interpreted as focal areas of inflammation at the level of the outer retina and inner choroid. The patient refused oral corticosteroids and any intravitreal injection therapies. Therefore, she was treated with two trans-Tenon's retrobulbar injections of triamcinolone acetonide after explaining the procedure and acquiring consent. The treatment resulted in a regression of inflammatory signs and a reduction of neovascular activity. No adverse events occurred for the mother or the baby, neither during the pregnancy nor after delivery.
Inflammatory CNV may be rarely associated with pregnancy. The correct diagnosis is crucial to allow the consideration of all possible management options. To the best of our knowledge, this is the first reported case of treatment with retrobulbar triamcinolone injections. This may represent a suitable therapeutic option in the absence of any other therapeutic approaches.
妊娠相关性脉络膜新生血管（CNV）极为罕见。在炎症性、特发性和近视性 CNV 之间进行鉴别诊断可能具有挑战性。此外，目前尚无关于管理的共识，并且由于患者和医生担心对胎儿有潜在风险，治疗选择可能会进一步受到限制。在此，我们报告一例妊娠期间发生的炎症性 CNV，并描述了一种以前未报道的治疗方法，即球后注射曲安奈德。
一名 36 岁女性，妊娠 21 周时出现右眼视力下降和视物变形。根据多模态影像学检查结果，她被诊断为炎症性 CNV：OCT 上呈 2 型病变，伴有“叉状征”，且不存在近视性 CNV 的断层影像学征象，自发荧光显示多个高自发荧光点，提示在外视网膜和内脉络膜水平存在局灶性炎症。患者拒绝口服皮质类固醇和任何玻璃体内注射治疗。因此，在向患者解释了该程序并获得同意后，对其进行了两次经 Tenon 氏囊球后曲安奈德注射治疗。治疗后炎症征象消退，新生血管活性降低。母亲和婴儿在妊娠期间和分娩后均未发生任何不良事件。
炎症性 CNV 可能与妊娠有关。正确诊断对于考虑所有可能的治疗方法至关重要。据我们所知，这是首例报道的球后注射曲安奈德治疗的病例。在没有其他治疗方法的情况下，这可能是一种合适的治疗选择。
