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Recalcitrant Diabetic Macular Edema Case Report despite Anti-Vascular Endothelial Growth Factor Therapy during
Lena Nour Juratli1, Claire Deng2, Yannis M Paulus2,3
1Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.
Introduction:
Anti-vascular endothelial growth factor (anti-VEGF) therapy is often the first-line treatment for diabetic macular edema (DME), but during pregnancy, focal laser photocoagulation is often preferred. We aim to report a case of anti-VEGF use during pregnancy for DME.
Case Presentation:
A 37-year-old pregnant female with a history of insulin-dependent, poorly controlled diabetes mellitus and proliferative diabetic retinopathy with macular edema presented with decreased vision. She had previously undergone focal laser therapy, but due to the appearance of symptomatic scotomas, had declined further focal laser treatment. Despite receiving intravitreal bevacizumab (IVB) injections, the patient's DME worsened during pregnancy. The patient had subsequent fetal loss and recurrent macular edema in both eyes after delivery.
Conclusion:
This report presents a severe case of DME that was recalcitrant to treatment with anti-VEGF treatment during pregnancy. The fetal loss is likely attributable to underlying medical conditions, including poorly controlled diabetes, hypertension, and congestive heart failure exacerbations requiring hospitalizations, rather than IVB. This case highlights the need for a multidisciplinary approach in pregnancy that combines optimized glycemic control and localized ocular therapy.
