Idiopathic multifocal choroiditis and punctate inner choroidopathy: an evaluation in pregnancy

Abstract

Purpose To evaluate the clinical course of idiopathic multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC) and the efficacy and safety of treatment options during pregnancy. Methods Patients with MFC or PIC and a pregnancy in 2011–2019 from two academic centres were enrolled. For the most recent pregnancy, data on best‐corrected visual acuity (BCVA) before and after pregnancy, relapse rate in pregnancy and postpartum period and obstetric, maternal and neonatal outcomes were collected. Treatment regimens consisted of a wait‐and‐see regime and an immunosuppressive treatment regime with systemic corticosteroids and/or azathioprine, both combined with intravitreal antivascular endothelial growth factor injections when indicated. Results Sixteen women (26 affected eyes) were included. Median Snellen BCVA was 20/19 before pregnancy and 20/18 after delivery. In seven pregnancies a wait‐and‐see regime and in nine pregnancies an immunosuppressive treatment regime was carried out. Fourteen intravitreal anti‐VEGF injections were given in six pregnancies. The relapse rate during pregnancy was 44% and in the postpartum period 31%. Maternal/obstetrical and fetal complications occurred in 31% and 13% of the pregnancies, respectively. Fifteen healthy children were born and one pregnancy ended in a stillbirth in a patient with a complicated obstetrical history. One patient treated with azathioprine developed intrahepatic cholestasis of pregnancy (ICP). Conclusions Among women with MFC and PIC BCVA remained stable during pregnancy despite a relapse rate of 44% in pregnancy. No major maternal, obstetric and fetal complications occurred in pregnant patients treated with systemic corticosteroids, azathioprine or intravitreal anti‐VEGF injections, though one patient developed ICP while treated with azathioprine.

Idiopathic Choroidal Neovascularization in Pregnancy: A Case Report

“…De Groot et al reported 14 IVT anti-VEGF injections in six pregnancies for multifocal choroiditis. Elevated IOP was reported in one patient who received concurrent IVT and systemic CS while another patient who developed multiple complications, already had a complicated obstetric history [ 10 ].…”

Idiopathische choroidale Neovaskularisation in der Schwangerschaft: ein Fallbericht

“…De Groot et al [10] berichteten von 14 intravitrealen Anti-VEGF-Injektionen bei 6 Schwangeren mit multifokaler Chorioiditis. Ein erhöhter Augeninnendruck wurde bei einer Patientin berichtet, die gleichzeitig intravitreale und systemische KS erhielt, während eine Patientin, die multiple Komplikationen entwickelte, bereits eine komplizierte obstetrische Vorgeschichte hatte [10].…”

Diagnostic & Therapeutic Challenges-

“…A study of women with multifocal choroiditis during pregnancy did not identify any abnormalities in the fetus, although this study was not designed to assess for subtle ocular pathologies in the offspring. 7…”

“…A study of women with multifocal choroiditis during pregnancy did not identify any abnormalities in the fetus, although this study was not designed to assess for subtle ocular pathologies in the offspring. 7 Optical coherence tomography angiography may be a helpful diagnostic tool in assessing patients with APMPPE. Indeed, optical coherence tomography angiography (OCTA) studies demonstrating choriocapillaris hypoperfusion lend support to theories regarding the role of the choroid in APMPPE.…”