Puza S W, Malee M P
Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
J Matern Fetal Med. 1996 Jan-Feb;5(1):7-10. doi: 10.1002/(SICI)1520-6661(199601/02)5:1<7::AID-MFM2>3.0.CO;2-U.
To determine the appropriate frequency of ophthalmologic examinations for retinopathy during gestation in diabetics categorized according to White's classification.
Retrospective review was performed over the period of 1989-1994. Inclusion criterion for gestational diabetics was a late second or early third trimester ophthalmologic examination. Inclusion criteria for classes B-R were a first trimester and third trimester or early postpartum examinations.
Of 300 charts reviewed, 100 met inclusion criteria. None of the gestational diabetics had retinopathy. Of class B patients (n = 21), 19% had retinopathy, with 11% progression in background retinopathy; none developed severe background or proliferative disease. In class C patients (n = 9), 56% had retinopathy, 33% with progression; none developed severe background or proliferative disease. Thirteen patients were class D; 92% had background retinopathy, in whom 45% showed progression, 31% with severe background retinopathy; none developed proliferative disease. Combined classes F, R, RF represented 13 patients; 100% demonstrated retinopathy; 46% progressed, 77% with proliferative disease; 15% required laser treatment during the pregnancy.
Routine ophthalmologic examinations in gestational (class A) diabetics have little utility. Results suggest that the need for subsequent ophthalmologic examinations can be based upon White's classification and initial examination results. Classes B and C do not require every trimester eye examinations. Rigorous follow-up is warranted in classes D-R.
