Poster Jesus Zarallo Gallardo

Introduction:

There are several retinal diseases that may worsen or alter during pregnancy as a result of hematologic, hormonal, metabolic, cardiovascular, and immunologic changes. Although normal pregnancy and its hypercoagulable state may induce retinal vein occlusion, hereditary or acquired changes in hemostatic factors increase the risk of thromboembolic events. The risk of venous thromboembolism in pregnancy is 0.05–1.8% and occurs most often in the third trimester and postpartum period. Anti-VEGF agents were the first drugs approved for macular edema in branch and central vein occlusion and they have good results in a monthly-based injection scheme. But the use of these drugs arises concerns about their safety and possible teratogenic effects in pregnant women, and multiple injections can make these adverse effects more frequent and severe. Triamcinolone has been proved safe in pregnant women when injected in the vitreous; its blood levels are very low. In vitro, dexamethasone shows less teratogenicity than triamcinolone, so its use can be justified. The use of a drug slow-releasing implant in the vitreous can make systemic levels even lower and could reduce the need of treatment to a single injection during the whole pregnancy.

Case report:

We present the case of a pregnant patient presenting with macular edema associated to central retinal vein occlusion in the first trimester of pregnancy. The patient began a treatment with aspirin and enoxaparin. After a period of eight weeks of observation, macular edema persisted and visual acuity was 0.1 so we decided to treat. After discussing with the patient pros and cons she was treated with a single dexamethasone intravitreal implant. Macular edema disappeared and there were neither maternal nor fetal adverse events.

Conclusion:

Intravitreal dexamethasone implant (Ozurdex®) in the vitreous may be a good option for the treatment of macular edema associated to retinal vein occlusion in pregnant women.