Pregnancy and the eye: What do we need to watch out for? A review.

Pregnancy causes changes in all body systems, including the eye. The eye can undergo physiological and pathological changes in pregnancy. Some changes exacerbate pre-existing eye conditions while other conditions manifest for the first-time during pregnancy. Early recognition and management are essential to prevent sight threatening complications. In addition, some obstetric complications can be associated with ophthalmic signs. Prompt recognition of these eye findings may be life saving for both the mother and the foetus. The aim of this article is to present potential ocular complications in pregnancy and outline the appropriate management to preserve sight and maintain maternal and foetal safety. The safety of the use of common ophthalmological medications will also be discussed.

Bleb vascularity following post-trabeculectomy subconjunctival bevacizumab: a pilot study.

BACKGROUND: To determine whether postoperative subconjunctival bevacizumab significantly alters bleb vascularity. DESIGN: A randomized, prospective interventional study. PARTICIPANTS: Forty-three eyes from 39 patients were recruited, with 21 eyes randomized to subconjunctival injections of 5-fluorouracil, and 22 eyes to combined 5-fluorouracil/bevacizumab. METHODS: All patients who underwent uncomplicated primary antimetabolite augmented trabeculectomy who subsequently required postoperative subconjunctival 5-fluorouracil injection within 4 weeks of surgery were eligible. Patients were randomized to receive subconjunctival 5-fluorouracil only (7.5 mg/0.15 mL) or 5-fluorouracil plus bevacizumab (1.25 mg/0.05 mL). MAIN OUTCOME MEASURES: Primary outcome was bleb vascularity with secondary endpoints including visual acuity, intraocular pressure, bleb morphology, complications and total numbers of 5-fluorouracil injections were recorded at baseline, week 12 and 18 months. RESULTS: At week 12, there was no significant difference between groups for visual acuity, intraocular pressure, bleb vascularity and morphology, or total number of 5-fluorouracil injections. By 18 months, 47.4% of the 5-fluorouracil/bevacizumab group exhibited central bleb avascularity compared with 21.1% of the 5-fluorouracil group (Fisher's exact test, P = 0.17). Two bleb complications (one blebitis; one suture abscess) recorded in the 5-fluorouracil/bevacizumab group. CONCLUSIONS: After a single combined injection, a trend for increased central bleb avascularity was observed, although this effect was not sufficient to reach statistical significance. This, in addition to the occurrence of two bleb-related complications in the bevacizumab group, suggests the need for a larger clinical trial to further evaluate the safety and efficacy of bevacizumab as a modulating agent in glaucoma filtration surgery.

Ophthalmic associations in pregnancy.

BACKGROUND: A range of ocular pathology exists during pregnancy. Some pre-existing eye conditions, such as diabetic retinopathy, can be exacerbated during pregnancy. Other conditions manifest for the first time during pregnancy as a result of complications such as pre-eclampsia and eclampsia. Early recognition and understanding of the management of ophthalmic conditions is crucial. OBJECTIVE: The aim of this article is to discuss the physiological and pathological changes in the eyes of pregnant women. Pathological changes are sub-divided into: 1) pre-existing eye conditions modified during pregnancy, 2) pathological conditions occurring for the first time and 3) ophthalmic associations due to complications in pregnancy. DISCUSSION: This article reviews the ophthalmic conditions that can manifest during pregnancy and discusses their pathophysiology and clinical implications. Recognition, history and examination of ophthalmic conditions and a diagnostic framework for referral are provided. Fundamental multidisciplinary care principles involving the primary care physician, ophthalmologist, rheumatologist or haematologist and obstetrician in the care of the pregnant patient are discussed.

Antifibrotic activity of bevacizumab on human Tenon's fibroblasts in vitro.

PURPOSE: To evaluate the effect of the anti-VEGF-A monoclonal antibody bevacizumab on primary human Tenon's capsule fibroblasts (HTFs) in an in vitro model of wound healing. METHODS: Fibroblasts were cultured in RPMI media, and bevacizumab was administered at a concentration ranging from 0.25 to 12.5 mg/mL. Fibroblast viability and cell death were assessed using the MTT colorimetric assay, lactate dehydrogenase assay, BrdU assay, and live/dead assay. Fibroblast contractility was assessed in floating collagen gels. Morphologic changes were assessed by transmission electron microscopy. Antifibrosis activities were compared with 5-fluorouracil. RESULTS: Bevacizumab induced a significant dose-related reduction of HTF cell number at 12.5 mg/mL at 72 hours (P < 0.05). Under serum-free conditions, bevacizumab induced significant fibroblast cell death at concentrations greater than 7.5 mg/mL (P < 0.05). Bevacizumab caused a moderate inhibition of fibroblast gel contraction from baseline (P < 0.05). Scanning electron microscopy revealed marked vacuolization in bevacizumab-treated fibroblasts. CONCLUSIONS: Bevacizumab disrupted fibroblast proliferation, inhibited collagen gel contraction ability, and induced fibroblast cell death at concentrations greater than 7.5 mg/mL in serum-free conditions. These results demonstrated that bevacizumab inhibited a number of fibrosis activities in culture. These activities may underpin the antifibrosis effect proposed in vivo.

Vascular changes after intra-bleb injection of bevacizumab.

PURPOSE: To illustrate changes in bleb vascularity after subconjunctival bevacizumab injection. METHODS: Longitudinal changes in bleb vascularity were followed over 6 months pre and postbevacizumab injection. RESULTS: Bleb vascularity associated with increased scarring activity was observed 10 days postcataract surgery in an eye that had undergone trabeculectomy 3 months previously. A single subconjunctival avastin injection led to a dramatic reduction in bleb vascularity for 6 weeks. With continued steroids, a diffuse, healthy, well functioning bleb with minimal scar tissue was present at 6 months. CONCLUSIONS: Subconjunctival injection of bevacizumab reduced bleb vascularity and may provide an adjunct to current antifibrosis therapy. Further studies to establish the effect of bevacizumab on postoperative scaring are warranted.