Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands.
Acta Ophthalmol. 2022 Feb;100(1):82-88. doi: 10.1111/aos.14898. Epub 2021 May 19.
To evaluate the clinical course of idiopathic multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC) and the efficacy and safety of treatment options during pregnancy.
Patients with MFC or PIC and a pregnancy in 2011-2019 from two academic centres were enrolled. For the most recent pregnancy, data on best-corrected visual acuity (BCVA) before and after pregnancy, relapse rate in pregnancy and postpartum period and obstetric, maternal and neonatal outcomes were collected. Treatment regimens consisted of a wait-and-see regime and an immunosuppressive treatment regime with systemic corticosteroids and/or azathioprine, both combined with intravitreal antivascular endothelial growth factor injections when indicated.
Sixteen women (26 affected eyes) were included. Median Snellen BCVA was 20/19 before pregnancy and 20/18 after delivery. In seven pregnancies a wait-and-see regime and in nine pregnancies an immunosuppressive treatment regime was carried out. Fourteen intravitreal anti-VEGF injections were given in six pregnancies. The relapse rate during pregnancy was 44% and in the postpartum period 31%. Maternal/obstetrical and fetal complications occurred in 31% and 13% of the pregnancies, respectively. Fifteen healthy children were born and one pregnancy ended in a stillbirth in a patient with a complicated obstetrical history. One patient treated with azathioprine developed intrahepatic cholestasis of pregnancy (ICP).
Among women with MFC and PIC BCVA remained stable during pregnancy despite a relapse rate of 44% in pregnancy. No major maternal, obstetric and fetal complications occurred in pregnant patients treated with systemic corticosteroids, azathioprine or intravitreal anti-VEGF injections, though one patient developed ICP while treated with azathioprine.
评估特发性多灶性脉络膜炎（MFC）和点状内层脉络膜病变（PIC）的临床病程，以及妊娠期间治疗选择的疗效和安全性。
纳入了 2011 年至 2019 年期间在两个学术中心就诊的 MFC 或 PIC 患者和妊娠。对于最近一次妊娠，收集了妊娠前后最佳矫正视力（BCVA）、妊娠和产后复发率以及产科、母婴和新生儿结局的数据。治疗方案包括观察等待方案和免疫抑制治疗方案，包括全身皮质类固醇和/或硫唑嘌呤，两者均在有指征时联合玻璃体内抗血管内皮生长因子注射。
共纳入 16 名女性（26 只受累眼）。妊娠前的中位 Snellen BCVA 为 20/19，产后为 20/18。在 7 例妊娠中采用观察等待方案，在 9 例妊娠中采用免疫抑制治疗方案。6 例妊娠中给予 14 次玻璃体内抗 VEGF 注射。妊娠期间的复发率为 44%，产后期间为 31%。分别有 31%和 13%的妊娠出现了母体/产科和胎儿并发症。15 名健康儿童出生，1 名患有复杂产科病史的患者妊娠中出现死胎。1 名接受硫唑嘌呤治疗的患者发生妊娠肝内胆汁淤积症（ICP）。
在患有 MFC 和 PIC 的女性中，尽管妊娠期间的复发率为 44%，但 BCVA 在妊娠期间保持稳定。接受全身皮质类固醇、硫唑嘌呤或玻璃体内抗 VEGF 注射治疗的妊娠患者未发生重大母体、产科和胎儿并发症，但 1 名接受硫唑嘌呤治疗的患者发生 ICP。
