Karska-Basta I

Cesarean section and eye disorders

Recently, a growing tendency for cesarean birth has been noted both, in Poland and worldwide. Non-obstetric problems constitute a large part of indications for cesarean section. Many ophthalmologists and obstetricians still believe that high myopia, the presence of peripheral retinal degenerations, history of retinal detachment surgery, diabetic retinopathy, or glaucoma are indications for surgical termination of pregnancy. However, these recommendations are not evidence-based. The literature offers no proof that high myopia and previous retinal surgery increase the risk of retinal detachment during spontaneous vaginal delivery. There is only one indication for cesarean section in myopic patients, i.e. the presence of choroidal neovascularization, which can cause subretinal bleeding with acute visual loss. Prolonged and intensified Valsalva maneuver during labor in patients with an active proliferative diabetic retinopathy may be an indication for an elective cesarean section. Uterine contractions during the second stage of vaginal delivery lead to a marked elevation of intraocular pressure. Intraocular pressure fluctuations during the delivery may damage retinal ganglion cells, resulting in further progression of visual field. Thus, glaucoma associated with advanced visual field changes is the next ophthalmic indication for cesarean section. The report presents the current state of knowledge concerning the effect of pregnancy on pre-existing ocular disorders and the influence of physiological changes on the clinical course of these diseases during the stages of natural delivery. The authors discuss also the ophthalmic indications for cesarean section.

Sudden Visual Deterioration as the First Symptom of Chronic Kidney Failure.

Purpose: We report here a unique case of a sudden loss of vision as the first symptom of an advanced chronic nephropathy. Methods and Results: A 25-year-old man was referred to the Department of Ophthalmology with sudden visual deterioration presumptively diagnosed as bilateral retinitis. The patient had never been under any medical care before and had never had any clinical signs of any chronic disease. He underwent an ophthalmic examination with optical coherence tomography (OCT). Based on the clinical features, OCT scans and systemic blood pressure (BP) assessment (225/145 mm Hg), the patient was definitely diagnosed with hypertensive retinopathy and choroidopathy due to hypertensive crisis. After urgent diagnostic procedures, the patient was diagnosed with a chronic kidney disease at stage 5 in the course of chronic glomerulonephritis. Immediately, a renal replacement therapy was started and the patient was qualified for renal transplantation. Conclusion: Adolescents with an unclear picture of retinal lesions, who have neither a history nor clinical signs of a systemic disease, should undergo careful systemic screening with BP assessment. A sudden deterioration of vision may be the first symptom of a previously undiagnosed severe systemic disease (very rare chronic) that requires immediate treatment.

Hypertensive Crisis-A Serious Problem in Medical Practice

There has recently been a considerable increase in interest in hypertensive crisis-a life-threatening condition. Recent publications indicate that hypertensive crisis is a problem not only in general medicine but also in ophthalmology. Visual disturbances may be the initial symptoms of severe hypertension and can reflect severe systemic changes. It seems appropriate to conduct further studies on the pathogenesis of vascular hypertensive changes, and particularly any associated inflammatory reactions. It also seems justified to introduce screening for hypertensive changes on the eye fundus photographs in emergency departments.