Diabetic macular oedema in the third trimester of pregnancy

The authors describe a case of a female patient with diabetes mellitus (DM) type 1 who faced a progress of diabetic retinopathy (DR) during her pregnancy with a development of diabetic macular oedema (DMO) and a deterioration of visual acuity (VA) in the right eye. The patient had been under observation for DM for 18 years, the last six years for the onset of the non-proliferative form of DR. During the 28th week of pregnancy, a significant reduction of visual acuity in the patient's right eye occurred as a result of a fast developing DMO. The patient was generally given corticosteroids for a gynaecological indication to accelerate the maturing of the foetus. Betamethasone (Diprophos) in dose 12mg with intramuscular application was administered twice in total, i.e. in the 29th and the 32nd week of pregnancy. After each application, a good effect was observed on the improvement of the visual acuity accompanied by a DMO reduction. However, the effect of corticosteroids was only temporary and at the end of their application in each case, a fast reduction of VA and a progression of DMO were observed, even though retinal laser photocoagulation was initiated. Delivery via Caesarean section was indicated in the 35th week of pregnancy, after a consultation with a diabetologist, gynaecologist and ophthalmologist. The delivery went without complications; both the child and the mother were in a normal condition after the delivery. A gradual improvement in VA was observed during the post-delivery period, with a reduction of DMO until a level of VA that corresponded to the status before the pregnancy was reached.

Keywords: diabetic macular oedema; corticosteroids; laser retinal photocoagulation