A 26-year-old woman with type 1 diabetes is seen at 10 weeks gestation. Dilated fundus examination reveals new vessels at the disc without macular involvement; visual acuity is normal. What is the correct management?

• A Defer all treatment until after delivery as laser harms the fetus
• B Advise termination of pregnancy as vision will be lost
• C Intravitreal anti-VEGF injection monthly until delivery
• D Perform panretinal scatter photocoagulation now, with intensive glycaemic control ✓

Explanation

Pregnancy can accelerate diabetic retinopathy, especially with rapid tightening of glycaemic control, and pre-existing proliferative change warrants prompt panretinal scatter photocoagulation during pregnancy. Laser is safe for the fetus and prevents progression to vitreous haemorrhage. Anti-VEGF agents cross the placenta and are avoided, and proliferative retinopathy does not mandate termination when treated appropriately.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.