Introduction
Diabetic retinopathy during pregnancy poses unique challenges. The risk factors increasing likelihood of progression of retinopathy have been elucidated in several studies and are discussed along with illustrative cases.
Cases
Illustrative cases are presented. Risk factors and treatments for retinopathy are discussed. Certain treatments are relatively contraindicated due to risk to the foetus. Anti-vascular endothelial growth factor injections are generally avoided leaving intravitreal dexamethasone as the treatment of choice where required for maculopathy despite the other significant potential ocular side effects (namely cataract and raised intraocular pressure).
Conclusion
Consistently, studies show the strongest risk factor for progression of retinopathy during pregnancy to be stage of retinopathy during first trimester. Tightening of glycaemic control is also associated with increased risk of progression but this is not clearly independent of retinopathy stage at presentation. Potential risks to both mother and foetus have to be considered when determining best treatments.