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Alexander Port, Ranjodh Singh, Daniel Kornberg, Anton Orlin, Donald J D'Amico, Mrinali P. Gupta, Szilard Kiss; Non-Mydriatic Retina Evaluation with Macular OCT and Ultra-Widefield Fundus Photography in Pregnant or Nursing Patients.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1862.
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A variety of conditions, such as diabetes and diabetic retinopathy, require ophthalmic evaluation during pregnancy or while a mother is nursing. Although harm to the mother or child attributable to pharmacological dilation has not been reported, many patients choose to defer dilated fundus evaluation during this time given the Category C FDA classification of these medications. With the availability of non-mydriatic retinal imaging, we sought to assess the utility of ultra-widefield fundus photography (UWF-FP) and macular optical coherence tomography (OCT) for initial evaluation and follow-up of patients who declined dilation.
Retrospective chart review of pregnant or nursing patients referred to the Weill Cornell Retina Service for dilated fundus exam who deferred pharmacologic dilation.
38 eyes of 19 patients (mean age 33 years, range 26 – 42) who underwent UWF-FP and OCT were included. Patients had a total of 37 clinical encounters (for a total 74 sets of images) over a mean follow-up of 6.63 ± 1.63 months. The most common indications for exam were diabetic evaluation (9/19 patients, 47%), followed by flashes/floaters (3/19 patients, 16%). Other retinal pathologies included vitelliform dystrophy (2), cone-rod dystrophy (1), acute central retinal vein occlusion (1), acute central retinal artery occlusion (1), acute central serous retinopathy (1) and pituitary tumor (1). Incidental findings included a peripheral atrophic retinal hole (1) and bilateral peripheral retinal hemorrhages (1). In all patients and eyes evaluated, non-mydriatic UWF-FP and OCT was sufficient to make the correct clinical diagnosis and form an appropriate treatment plan. No new or differing pathology was noted in any of the follow-up images nor in the 26 eyes that have subsequently undergone a complete dilated exam.
Although not a substitute for comprehensive dilated evaluation, undilated UWF-FP and OCT may be a reasonable alternative in pregnant and nursing patients. In our series, non-mydriatic imaging was able to adequately evaluate retinal pathology for reasonable clinical decision making in all eyes. During follow-up no new nor significantly different retinal pathology was uncovered that would have altered diagnosis or treatment recommendations. Larger, prospective series are undoubtedly needed to confirm our findings.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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