Evaluarea și tratamentul retinopatiei diabetice în sarcină
Cuvinte cheie:
retinopatie diabetică, sarcina, fotocoagularecu laser, steroizi cu injectare intravitreană, anti-VEGFRezumat
Prevalența retinopatiei diabetice (RD) continuă să crească la femeile însărcinate. Lipsa studiilor privind siguranța și eficiența opțiunilor actuale de tratament în timpul sarcinii face ca managementul bolii să fie deosebit de dificil. Toate femeile însărcinate cu diabet zaharat ar trebui să efectueze un screening prenatal al RD, precum și să primească recomandări cu privire la evoluția și managementul RD în timpul sarcinii. Trebuie recomandat controlul optim al glicemiei și al tensiunii arteriale. Pentru pacienții cu retinopatie diabetică proliferativă (RDP) în absența unui edem macular diabetic (EMD) semnificativ, fotocoagularea panretinală rămâne o opțiune de tratament sigură și eficientă. Edemul macular diabetic semnificativ poate fi tratat cu laser focal, dacă se identifică zone de leakage focal în maculă, steroizi cu injectare intravitreană sau agenți inhibitori de creştere a endoteliului vascular (anti-VEGF). Trebuie de luat în considerare riscul teoretic al agenților anti-VEGF pentru făt, de aceea pacientele trebuie să fie informate cu privire la riscurile și beneficiile terapiei anti-VEGF înainte de inițierea tratamentului. Atunci când se ia decizia de a trata cu agenți anti-VEGF, Ranibizumab ar trebui să fie agentul de elecție. În concluzie, oftalmologii ar trebui să ia decizii de tratament la pacientele gravide cu RD pentru fiecare caz în parte, luând în considerare severitatea bolii, riscul de scădere permanentă a vederii, termenul de gestație și preferințele pacientei.
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