Mehdi Imran
Ophthalmology, Tata Main Hospital, Jamshedpur, IND.
Cureus. 2024 Apr 17;16(4):e58458. doi: 10.7759/cureus.58458. eCollection 2024 Apr.
The management of choroidal neovascularization (CNVM) in pregnant young females has been a lacuna due to the rarity of the condition as well as the non-availability of comprehensive data to showcase the efficacy of currently available treatment regimes in order to achieve a positive outcome for both the growing fetus as well the patient herself. In a review of available literature, the condition has been treated with anti-vascular endothelial growth factors (anti-VEGF), laser photocoagulation, and intravitreal dexamethasone implants (IDI), with varied results ranging from the successful outcome in terms of pregnancy to abortions. When faced with such circumstances, healthcare professionals usually proceed cautiously, balancing the possible advantages against the hazards to the mother and the fetus. Here we present a case report of a young 30-year-old pregnant lady who developed idiopathic CNVM during her third month of gestation. Being a rare entity, CNVM in young pregnant women raises severe concerns due to potential consequences on the mother's and fetus's health. In certain previously documented cases, pregnant ladies with CNVM have been successfully treated with IDI. Hence, after much deliberation, we chose to go with IDI rather than anti-VEGF, which resulted in the successful management of her CNVM as well as achieving full-term normal delivery without any fetal anomalies. In this particular case, the pregnancy and the visual rehabilitation have both had favorable outcomes. There was no associated increased intraocular pressure (IOP) or changes to the lenticular structure. The literature review also suggests that IDI may still be as effective in managing CNVM during pregnancy, but at a lower risk than anti-VEGF drug. Even with the favorable outcomes revealed in case reports, larger-scale studies to properly examine IDI's safety profile would be required for regulatory clearance of its safety in pregnancy.
由于脉络膜新生血管（CNVM）在年轻孕妇中较为罕见，且缺乏全面数据来展示现有治疗方案的疗效，以实现对发育中的胎儿和患者自身都有积极结果，因此对其管理一直存在空白。在对现有文献的回顾中，该病症已采用抗血管内皮生长因子（抗VEGF）、激光光凝和玻璃体内地塞米松植入物（IDI）进行治疗，结果各异，从妊娠成功到流产不等。面对这种情况时，医疗保健专业人员通常会谨慎行事，权衡可能的益处与对母亲和胎儿的危害。在此，我们报告一例30岁年轻孕妇的病例，她在妊娠第三个月时患上特发性CNVM。作为一种罕见病症，年轻孕妇中的CNVM因其对母亲和胎儿健康的潜在影响而引发严重担忧。在某些先前记录的病例中，患有CNVM的孕妇已通过IDI成功治疗。因此，经过深思熟虑，我们选择采用IDI而非抗VEGF，这使得她的CNVM得到成功管理，并实现了足月正常分娩，且胎儿无任何异常。在这个特殊病例中，妊娠和视力康复均取得了良好结果。没有相关的眼内压（IOP）升高或晶状体结构改变。文献综述还表明，IDI在孕期管理CNVM方面可能仍然有效，但风险低于抗VEGF药物。即使病例报告显示出良好结果，仍需要进行大规模研究以正确检查IDI在孕期的安全性，以便监管部门批准其在孕期的安全性。
