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High Miopia in pregnant women, the management and profilactics of occular complications


Author: Garaba Angela
Degree:doctor of medicine
Speciality: 14.00.08 - Ophthalmology
Year:2009
Scientific adviser: Eugen Bendelic
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Valentin Friptu
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:

Status

The thesis was presented on the 8 April, 2009
Approved by NCAA on the 18 June, 2009

Abstract

Adobe PDF document0.48 Mb / in romanian

Keywords

High miopia, pregnancy, gestoses, labour, intraoccular pressure

Summary

The thesis included 4 study groups, one of the compartimets reflects the results of clinical-functional status of 90 pregnant women (group I of study) with high miopia (HM) in 136 eyes. They were examined and observed the entire pregnancy period and postnatal in order to elaborate the optimal management for prevention of the occular complications.

Durring the entire pregnancy and postnatal period (PNP) of pregnant high miopic women the refractometrical statuses (subjective and objective) and visual functions (visiometry, perimetry) were stable, but it is observed a improvement of cylindric status of occular refraction in PNP comparing to the second half of the pregnancy period - due to no progression of the miopia. The dimenssions of the miopic eye remained stable durring the entire pregnancy and PNP, reffering to the obvious correlation between the biometric parametres and corioretinal changes, their frequency raises concomitent with the ocular dimensions and the miopic optical correction, but without preexisting occular modiffications agravations or the appearing of new ones. The prognosis of the occular complications durring the labour per vias naturalis (PVN), is to be based on the presence and the severity of the vitreochorioretinal modifications at high miopic women, as well as other degrees of miopia, and the obstetrical status: the presence and severity of the tardive gestoses - the occular and obstetrical changes are influencing the ophthalmological prognosis. The photolasercoagulation of the retina, effecteted at least 2 months prenataly, remains the optimal method of prevention and minimalisation of the occular complications, especcialy the retinal detachement durring the pregnancy and PVN labour at miopic women with vitrocorioretinal disftrofies.

Second study group included 345 clinical cases of pregnant miopic women, also with HM - had the purpose to evaluate the possible occular complications, most of all durring labour. As in miopia over „-6,0” D as well as in general miopia there were not occular complications indifferent of the birth modality.

The IOP variation in a 30 (study group III) pregnant women during the labour and early PNP was studied. It is observed during PVN labour increase of IOP, but in normal limits, mostly in second labour period (of expulsion) comparative to the anterior period of birth; and a slight decreassing of the IOP during early PNP.

The fourth study group was based on the evaluation and comparative and correlative analysys of occular modifications in pregnant women (249 cases) with miopia with and without gestoses (lot 1 and 2), with correlation between associated opthalmological pathologies and the management of the birth; between the management of pregnancy, labour and the opthalmoscopic gestosic modifications as well as miopic ones, which correleted with the degree of miopia.

The study results offered the possibility to elaborate a management algorythm of pregnant miopic women, inclusive high miopic women during the pregnancy an PNP, which contains the diagnosis methods, and curative opthalmlological interventions specifying the decission criteria of the labour management, in order to reduce the occular complications. The elaborated schema of ophthalmologic prognosis at pregnant high miopic women durring PVN labour contains the criteria of miopic modifications (vitreocorioretinal distrofies) in association with obstetrical pathology (gestoses).