Pregnancy and diabetic retinopathy: assessment and treatment

The prevalence of diabetic retinopathy (DR) continues to increase in pregnant women. The lack of studies on the safety and efficacy of current treatment options during pregnancy makes management of the disease particularly challenging. All pregnant women with diabetes should undergo prenatal screening for DR as well as receive advice on the course and management of DR during pregnancy. Optimal control of blood glucose and blood pressure should be recommended. For patients with proliferative diabetic retinopathy (PDR) in the absence of significant diabetic macular edema (DME), pan-retinal photocoagulation remains a safe and effective treatment option. Significant diabetic macular edema can be treated with a focal laser if focal leakage areas are identified in the macula, intravitreally introduced steroids or anti-VEGF agents. The theoretical risk of anti-VEGF agents to the fetus must be considered so patients should be informed of the risks and benefits of anti-VEGF therapy before treatment is initiated. When deciding to treat with anti-VEGF agents, Ranibizumab should be the agent of choice. In conclusion, ophthalmologists should make treatment decisions in pregnant patients with DR on a case-by-case basis, taking into account disease severity, risk of permanent vision loss, gestational term, and patient preferences.