Cesk Slov Oftalmol. 2022 Spring;78(2):79-83. doi: 10.31348/2022/11.
To present the case of a patient with myopic choroidal neovascular membrane (mCNV) in the 3rd trimester of pregnancy, who was treated with intravitreal ranibizumab.
The 34-year-old patient was referred to the Department of Ophthalmology of the University Hospital Kralovske Vinohrady in January 2020 for mCNV on her right eye (RE). The patient was in the 34th week of pregnancy. Initial best corrected visual acuity (BCVA) was 68 ETDRS letters. Spherical equivalent of the RE was -11.5 dioptres, axial length of the RE was 27.7 mm. Pigmented CNV with small haemorrhage was present on the retina of the RE. Optical coherence tomography (OCT) of the RE showed a hyperreflective mass above the retinal pigment epithelium, central retinal thickness (CRT) was 310 µm. OCT angiography confirmed the presence of a classic CNV in the macula of the RE. Two weeks later, the hyperreflective lesion and oedema in the macula of the RE increased, the CRT was 329 µm, BCVA remained stable. After discussion with the patient and the treating gynaecologist, intravitreal ranibizumab was administered in the RE in the 36th week of pregnancy. On check-up 3 weeks later, we observed the decrease of macular oedema to 276 µm and the improvement of BCVA to 78 ETDRS letters. The patient delivered a healthy baby girl in the 39th week of pregnancy via caesarean section, postnatal adaptation of the newborn was normal. During further visits, the BCVA improved to 83 ETDRS letters and the macular oedema disappeared completely. 8 months after the first ranibizumab injection, the CNV reactivated, BCVA decreased to 72 ETDRS letters, oedema was present in the macula and the CRT was 309 µm. Another ranibizumab was administered into the RE. The patient then discovered that she was pregnant; according to calculations, she was in the 3rd week of pregnancy at the time of the second ranibizumab injection. After the second injection, BCVA improved to 79 ETDRS letters, macular oedema on the OCT disappeared and CRT decreased to 264 µm. The pregnancy was terminated per patients request.
Intravitreal administration of ranibizumab in the 3rd trimester of pregnancy led to the improvement of BCVA and decrease of macular oedema in the patient with mCNV. The injection had no adverse effect on the pregnancy or the postnatal adaptation of the newborn. However, it is always necessary to consider the risk/benefit ratio when administering intravitreal antiVEGF drugs in pregnant patients. Thorough discussion with the patient is necessary.
介绍一例妊娠 3 个月的近视性脉络膜新生血管膜（mCNV）患者，该患者接受了玻璃体内雷珠单抗治疗。
这名 34 岁的患者于 2020 年 1 月因右眼 mCNV 被转诊至克拉罗维采尼霍拉迪大学医院眼科。当时她处于妊娠 34 周。最佳矫正视力（BCVA）初始值为 68 ETDRS 字母。右眼的等效球镜为-11.5 屈光度，眼轴长度为 27.7 毫米。右眼视网膜上有色素性 CNV 伴小出血。右眼 OCT 显示视网膜色素上皮上方有一个高反射性肿块，中央视网膜厚度（CRT）为 310 微米。OCT 血管造影证实右眼黄斑区存在典型的 CNV。两周后，右眼黄斑区的高反射性病变和水肿增加，CRT 为 329 微米，BCVA 保持稳定。在与患者和主治妇科医生讨论后，在妊娠 36 周时对右眼进行了玻璃体内雷珠单抗注射。3 周后的复查显示黄斑水肿减少至 276 微米，BCVA 提高至 78 ETDRS 字母。患者于妊娠 39 周行剖宫产分娩出一名健康女婴，新生儿产后适应良好。在进一步的就诊中，BCVA 提高至 83 ETDRS 字母，黄斑水肿完全消失。首次雷珠单抗注射后 8 个月，CNV 再次活跃，BCVA 下降至 72 ETDRS 字母，黄斑区出现水肿，CRT 为 309 微米。对右眼再次进行了雷珠单抗注射。此时患者发现自己怀孕了；根据计算，第二次注射时她处于妊娠第 3 周。第二次注射后，BCVA 提高至 79 ETDRS 字母，OCT 上黄斑水肿消失，CRT 下降至 264 微米。患者要求终止妊娠。
在妊娠 3 个月时对 mCNV 患者进行玻璃体内雷珠单抗注射，可改善 BCVA 和黄斑水肿。该注射对妊娠或新生儿产后适应无不良影响。然而，在对孕妇进行玻璃体内抗 VEGF 药物治疗时，始终需要考虑风险/获益比。与患者进行彻底的讨论是必要的。
