Re : managment of RD in young pregnant lady Posted By sharad malavade Date : 27-Mar-07
Patient is a primigravida, so assuming that the patient is young, the RPE is expected to be healthy. the cause of loss of vision of the other eye needs to be investigated in a more elaborate manner if possible.The patient is primigravida with 8 months gestation. we must consider certain issues 1. any surgery would have to be under local surgery so as to prevent any undue effects of General anaesthesia on the foetus.
2. The patient is going to be very anxious due to this being her first ptregnancy and she being rendered blind due to the detachment. therefore during surgery the patient needs sdatives pre and intra-operatively.also the patient needs reassuarance and counselling regarding the guarded prognosis of the treatment modality.
3. The best way to treat would be ideally vitrectomy+ FAE+ EL+ Air/Gas/Silicon oil with a segmental scleral buckle. But Injection of an internal tamponading agent like Gas or Silicon oil would mean a possible need for IOP lowering drugs like Acetazolamide. At 8 months gestations the main concern for us would be induction of fetal metabolic acidosis due to Acetazolamide, hence we need to explore other IOP lowering agents which would be safer for both the patient and the foetus like topical agents or oral glycerin.I/V mannitol may cause a systemic overload and if the patient is a case of Marfan's then,that too is frought with risk.
Hence what i would prefer is an initial attempt at settling the detached retina by a Scleral buckle with drainage +/- air injection. Close monitoring during post-op period is necessary. if required additional laser barrage by indirect ophthalmoscope around any missed break/ fresh break/ lifted break. If the retinal detachment still does not seetle within 1-2 weeks then vit+FAE+ EL+ GAS injection with any additional buckle as deemed necessary may be done.
the point to be be strssed here is the ophthalmologist must never forget that he is treating not one but two patints- the mother and thru her the unborn child.