The influence of pregnancy changes on myopic patients’ eyes S. Kwiecień, M. Pawluczyk - Dyjecińska, A. Sokołowska - Oracz, J.Szaflik Department of Ophthalmology, Medical University of Warsaw, Poland Ophtalmology Outpatient Clinic of Hospital Gynecology and Maternity "Livonian"

The aims of our study were to establish ocular indications to: Indications to type of delivery can be difficult in case of high myopic patients or with degenerations of peripheral retina. Intraocular pressure changes and Valsalva mechanism can have influence on retinal tears and retinal detachment appearing. The aims of our study were to establish ocular indications to: type of delivery, laser photocoagulation, The aim of our study was also to find any ocular changes which occur during pregnancy.

Material 102 eyes - 51 patients (age: 24 – 39, mean 30,5) 21 – 40 Hbd, mean 33 Hbd Method Orbscan, USG, OCT and a complete ophthalmologic examination were performed during pregnancy and min 6 months after delivery. Laser treatment was performed in vitreo-retinal traction and tears presence: I examination: 2 days – 16 weeks before delivery mean 7 weaks II examination: 1 – 19 months after delivery mean 9,5 months

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Refraction Intracular pression Increase of myopia 0,75 – 1,5 dsph Stabilisation -0,5 → +0,5 dsph Decrease of myopia 0,75 – 1,0 dsph Total 34,6% 47,4% 18% patients’ -observation span - from 9 to19 months 21,8% 67,2% 11% Intracular pression Increase after delivery 1 – 6 mmHg stabilisation Decrease after delivery 1 – 4 mmHg 46,7% 23,3% 30%

Macular thickness- OCT Pachymetry Decrease after delivery 6 – 51 μm Stabilisation -5 → +5 μm Increase after delivery 6 – 8 μm 83,8% 1,5% 14,7% Macular thickness- OCT Increase of macular thickness after delivery 1 - 37 μm Mean 9 μm 73 % Decrease of macular thickness after delivery 1 - 38 μm Mean 11 μm 27 %

Biometry Lenght of the eye globe Below 26 mm Above 26 mm 78,2% 21,8% Decrease of the globe’s length 0,1 – 0,25 mm Increase of the globe’s length0,1 – 0,17 mm Stabilisation 73% 26% 1%

Vitreous attachment - results I exam initial PVD I exam total PVD I exam vitreous attachment II exam initial PVD II exam total PVD II exam vitreous attachment Total 58,7% 27% 14,3% 46,5% 39,6% 13,8% Spontaneous delivery 50% 27,3% 22,7% 36,4% 13,6% Delivery by Caesarean section 56,2% 31,2% 12,6% 37,5% 12,5% Instrumental delivery 2 patients 100% 0%

Eyes after laser Peripheral retinal degenerations Total the globe’s length ↑ 26mmHg Szroniaste 42,2% 80% Normal retina 40,8% 5% Retinal tears 6% - Lattice 4% 15% Pigment aggregation Retinoschisis 3% Eyes after laser yes no Total 38,4% 61,6% the globe’s length ↑ 26mmHg 57,1% 42,9%

Vitreous attachment after laser treatment time to delivery : 3 days – 4 months / mean 6 weeks Total ↑ 26mmHg Without changes 80% 31,3% Total PVD 5% 43,7% Initial PVD 15% 25%

Results Refraction changes 52,6% (↑-34,6%;↓-18%), Persistent increase of myopia after delivery 21,8% Decrease of intraocular pressure during pregnanacy Increase of pachymery during pregnancy 83,8% Slight decrease of the globe’s length 76% Slight influence of laser on PVD generating PVD after delivery SN – 45,4%, CC- 37,6%

Indications for laser treatment Peripheral retinal degenerations with vitreoretinal tractions Retinal tears and holes because of PVD appearance, laser treatment before delivery is indicated laser treatment can be performed at any time during pregnancy

Qualification for type of delivery Spontaneous delivery even after laser treatment Cesarean section: Acute PVD with retinal tears and vitreous hemarrage Retinal detachment after operation up to 1 year before delivery Active subretinal neovascularisation - Fostera-Fuchsa ? Advanced glaucoma with scant visual field ?