Management of uveitic and chorioretinal conditions in pregnancy

During pregnancy, women may develop de novo sight-threatening chorioretinal diseases or experience exacerbations of these conditions. Examples include macular neovascularisation, diabetic macular oedema, and posterior uveitis. Ophthalmologists may not necessarily recommend the standard treatment for these disorders when they arise in pregnant women due to a lack of evidence regarding safety and potential risks of teratogenicity and fetotoxicity, and a lack of experience with managing this patient population. However, withholding treatment may lead to irreversible maternal vision loss. In this review, we discuss therapies that may need to be considered in these conditions, including steroids, intraocular pressure-lowering treatment for steroid-induced glaucoma, systemic immunosuppressants, and intravitreal anti-vascular endothelial growth factor agents. We discuss the evidence base behind these treatments in terms of safety in pregnancy, bringing in the obstetric perspective. We also discuss common misconceptions surrounding different modes of delivery in pregnant women with chorioretinal disease.