EURETINA 2026: Women’s health and pregnancy in the spotlight

Women’s health is coming into sharper focus more often that previously with the recognition that hormones do make a difference. Here’s preview of studies of cases of pregnancy slated for discussion at the upcoming EURETINA 2026 meeting on October 1-4 in Vienna.

• Diabetic retinopathy can reactivate during pregnancy in women with type 1 diabetes

Portuguese investigators from the Associação Protetora dos Diabéticos de Portugal, in Lisbon, conducted a retrospective review of four clinical cases that suggested that pregnant women with preexisting type 1 diabetes and established diabetic retinopathy (DR) have a significant risk of disease progression while pregnant. That risk remains despite previous treatment of the retinopathy.

All patients were aged 20 to 30 years and had long-standing diabetes from 11 to 23 years. At baseline, the DR ranged from severe non-proliferative DR to previously treated proliferative DR.

Glycemic control before pregnancy was suboptimal to moderate, with HbA1c values of 6.0% to 9.7%. Only one patient attended preconception evaluations; the other three had irregular follow-up at the diabetes department before pregnancy.

Two patients had abrupt reductions in HbA1c in early pregnancy and reported recurrent hypoglycemic episodes; a third patient had a significant decline in HbA1c throughout gestation.

Between 12 and 35 weeks gestation, each patient had a significant ocular events, ie, preretinal hemorrhage with fibroproliferation, vitreous hemorrhage with neovascular activity, retrohyaloid hemorrhage with visual loss, and progression to proliferative retinopathy and preretinal hemorrhage.

During pregnancy, one patient underwent vitrectomy with supplementary laser, two patients were observed, and one had attempted panphotocoagulation late in pregnancy. Postpartum management included continued surveillance, resumption of intravitreal anti-vascular endothelial growth factor therapy (VEGF), and completion of panphotocoagulation. The final visual acuities ranged from 0 to 0.15 logarithm of the minimum angle of resolution.

The authors concluded that pregnant women with preexisting proliferative or severe non-proliferative DR remain at significant risk of disease reactivation during pregnancy. This includes women previously treated with panretinal photocoagulation. Rapid glycemic improvement, seen in three of the four patients, may contribute to DR worsening.

Timely intervention, including laser photocoagulation and vitrectomy when indicated, can result in favorable visual outcomes. Considering theoretical fetal risks, anti-VEGF therapy may be deferred until the postpartum period. The findings underscore the importance of preconception counselling, glycemic control, and collaboration between ophthalmology and obstetrics in this high-risk population, the investigators emphasized.

• Maternal optical coherence tomography angiography changes may signal placental insufficiency in fetal growth restriction.

A cross-sectional Turkish study suggested that the maternal retina may give a measurable view of the microvascular changes linked to fetal growth restriction (FGR). The study found higher retinal and choroidal vascular metrics in women whose pregnancies were complicated by FGR.

The authors used optical coherence tomography angiography (OCTA) to study maternal retinal microvascular changes in FGR pregnancies and the findings were compared with pregnancies involving fetuses appropriate for gestational age (AGA).

The study included 44 eyes of 22 women with FGR pregnancies and 48 eyes of 24 women with AGA pregnancies. All were singleton gestations; all participants had 20/20 vision.

On OCTA, the FGR group had significantly higher superficial capillary plexus whole vessel density (p=0.020), deep capillary plexus whole vessel density (p=0.043), deep capillary plexus foveal vessel density (p=0.027), and choriocapillaris flow area (p<0.001). The groups did not differ significantly on the remaining superficial capillary plexus and deep capillary plexus sectoral measures, foveal avascular zone area and perimeter, outer retinal flow area, or subfoveal choroidal thickness.

The authors suggested that the increased vascular metrics may reflect compensatory microvascular changes secondary to placental insufficiency. Retinal blood flow is tightly autoregulated by vasoactive mediators, and similar mechanisms occur in the cerebral circulation during pregnancy and hypertensive disorders of pregnancy. In FGR, placental insufficiency may increase circulating bioactive factors that affect the systemic and retinal vasculature, they explained.

They proposed that OCTA parameters could complement Doppler ultrasonography and biochemical markers. OCTA could serve as a promising non-invasive tool for risk assessment and monitoring in FGR pregnancies.

• Bilateral choroidal osteoma causing choroidal neovascularization in a pregnant patient.

Investigators from the UK described a 30-year-old woman with bilateral choroidal osteoma and secondary unilateral choroidal neovascularization (CNV) and how pregnancy can complicate the diagnosis and treatment of this rare condition.

While choroidal osteoma is a benign and infrequent choroidal tumor whose appearance can closely overlap with inflammatory or infectious chorioretinal disorders, limited safety data restrict certain imaging modalities and therapies during pregnancy.

The patient, a native of Bangladesh who lived in the UK for 4 years, presented to the emergency department during her first trimester. She reported several weeks of bilateral metamorphopsia and decreasing vision. She reported long-standing poor vision in the left eye since childhood. The systemic history was unremarkable.

The visual acuity was 6/21 in the right eye and counting fingers in the left. The authors reported that the left eye had inactive stromal keratitis, and the right fundus had a hypopigmented serpiginous-like lesion extending from the disc along the inferotemporal arcade, with a supratemporal hemorrhage. The left fundus had a large hypopigmented posterior pole lesion with subretinal scarring.

OCT showed bilateral choroidal hyperreflectivity, with subretinal fluid on the right and subretinal scarring on the left. OCTA confirmed active CNV in the right eye. A comprehensive infectious and inflammatory panel was largely unremarkable, with two exceptions: a moderately elevated erythrocyte sedimentation rate and borderline positive toxoplasma IgM that did not suggest recent infection. B-scan ultrasound showed hyperechogenic material consistent with mature bone, which established the diagnosis of bilateral choroidal osteoma.

The patient declined anti-VEGF therapy because of limited safety evidence in pregnancy. The vision worsened, the subretinal fluid increased, and a growing pigment epithelium detachment suggested a developing polyp. Two weeks postpartum, fluorescein and indocyanine green angiography confirmed active CNV. Off-label bevacizumab was started, with a suboptimal early response.

The authors emphasized that bilateral choroidal osteoma is even more unusual than unilateral disease. The serpiginous-like atrophy raised suspicion of inflammatory or infectious causes, and multimodal imaging was essential to reach the correct diagnosis. Pregnancy-related constraints delayed treatment, which likely allowed further CNV progression and polyp development. The suboptimal response to bevacizumab is consistent with reports that CNV secondary to choroidal osteoma can be chronic and variably responsive to therapy, they said.

The case supports considering choroidal osteoma in young women with atypical chorioretinal lesions and subretinal deposits and shows the need for tailored counselling during pregnancy, weighing diagnostic accuracy, potential risks, and the consequences of postponing treatment.