Management of a rhegmatogenous retinal detachment in a pregn
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Pregnancy can be associated with a myriad of ocular changes from physiologic to pathology. The majority of ocular changes are benign and physiologic, such as the 14% of women who experience a refractive change during their pregnancy. However, pathologic ocular changes, such as exudative retinal detachments, are more likely to occur in patients with concurrent pre-eclampsia and eclampsia. Though ophthalmic conditions such as exudative retinal detachments have been documented during pregnancy, reports of rhegmatogenous retinal detachment (RRD) and operative management are uncommon.

A 30-year old, 26-weeks pregnant, myopic female without other ocular history reported 5 days of a “shadow” in the left eye. The pregnancy had been uncomplicated thus far.
On examination, her best-corrected visual acuity was 20/20 OU, with no afferent pupillary defect. The patient had a left superio-temporal visual field defect to confrontation. The patient was phakic with a positive Shaffer sign on the left. Fundus examination of the left eye revealed an inferior retinal detachment, fluid extending into the inferior macula, and a hole at 5:30

Maternal-fetal medicine performed pre and post-operative non-stress testing (NST). Surgery was performed using monitored anesthesia care with intravenous fentanyl and midazolam and a sub-tenons block of lidocaine and bupivacaine. The patient underwent placement of a 41 scleral buckle with cryotherapy to the causative break and 0.4 cc of 100% C3F8 was injected as the patient had demonstrated an ability to position on her side with face down. At 4 months post-operatively the retina remains attached. At 39 weeks the patient delivered a healthy female via uncomplicated spontaneous delivery.

In conclusion, safe and successful treatment of RRD in pregnant patients can be achieved with careful coordination between ophthalmology, anesthesia, and obstetrics. An understanding of pregnancy-specific considerations is important in order to optimize patient outcomes.

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