Miopia dalam

Kehamilan dan
Penangannya
Definisi

 Miopia (nearsightedness) adalah suatu kelainan refraksi

dimana sinar-sinar sejajar masuk ke bola mata tanpa
akomodasi akan dibiaskan di depan retina.
Jenis Miopia berdasarkan berat
derajatnya
 Miopia ringan (levior) < 3 dioptric
 Miopia sedang (moderate) 3-6 dioptric
 Miopia berat (Gravior) > 6 dioptri
Miopia dan Kehamilan
 Miopia merupakan
Miopia patologis : ukuran
permasalahan global
refraksi > 6.00 D atau
dengan prevalensi dan
panjang aksial >26.5mm. 
frekuensi, dan tingkat
resiko tinggi untuk penyakit
keparahan yang meningkat
degenerasi progresif retina.
belakangan ini

Ablasio retina, degenerasi

retina pada macula,
Komplikasi dari myopia
perdarahan dibalik retina,
patologis semakin
terbentuknya membrane
meningkat selama
koroidalis neovaskular dan
kehamilan dan persalinan.
terbentuknya lubang
macula,
Pengaruh Kehamilan terhadap
Fisiologi Okular
Retensi air ↓sensitivitas
kornea dan ↑ketebalan dan
kurvatur kornea
Pada pertengahan
kehamilan terjadi ↓tekanan
intraocular pada mata normal,
pada pasien yang telah menderita
ocular hipertensi dapat berefek
lebih besar
Muncul biasanya saat akhir
kehamilan dan
menyebabkan perubahan
temporer pada refraksi
↑aliran akuos, ↓tekanan vena
eiskleral, ↓rigiditas sclera dan
asidosis menyeluruh selama
kehamilan .
Tekanan intraocular akan kembali
setelah 2 bulan postpartum
Miopia pada Kehamilan
Saat hamil peningkatan myopia
biasa terjadi dan pada
umumnya akan kembali setelah
partus atau menyusui
14% dari wanita hamil
mengalami perubahan pada
Kornea meningkat
akuitas penglihatan, gangguan
ketebalannya antara 1-16μm
refraksi dan perubahan myopia
selama perubahan edema
yang akan kembali normal
dikarenakan retensi cairan
dalam beberapa bulan setelah
partus.
Partus Pervaginam atau Seksio
Sesarea?

Miopia dan faktor risiko lain untuk

ablasio retina sering digunakan
sebagai indikasi seksio. Hal ini
dikarenakan pada kala II persalinan
risiko ablasio meningkat. Dan indikasi
Seksio biasanya merupakan atribut
ophtalmologis
Landau, D et al. (1995):
studied 10 women who had 19 deliveries (10 prospective and 9
retrospective) ,who had a history of retinal detachment, had been
diagnosed as having extensive lattice degeneration, or had been treated
for symptomatic retinal holes or breaks. The women were followed from
the third trimester of pregnancy through labor and delivery into the
postpartum period, looking for changes in the retinal status.

Results: No changes in the retinal status in the postpartum examination.

Conclusion: We conclude that prenatal treatment of asymptomatic retinal

pathology is not indicated and that spontaneous vaginal delivery may be
allowed to take place in women with high-risk retinal pathology.
 Katsulov A. (1999) et al: describe 7 cases of pregnant women
with high myopia to 15 diopters, who have been delivered
vaginally without worsening of the vision and especially of
the myopia.

 A. Neri (2005) et al: Various obstetrical data were recorded in

50 women with myopia from 4.5 to 15.0 diopters who were
admitted in labor. Fundus examination was performed in all of
them before and after delivery. Various types of retinal
degeneration and retinal breaks were observed in most of
them at their arrival but no deterioration of these retinal
defects was observed in any of the cases at the later
examination.
Ghaem-Maghami S et al,(2006):
Choroidal neovascularization (CNV) ,
develop 5 % from total high myopic
patients. Up 90 % from them will
deteriote to 6/60 vision within 5 year.
CNV  treated by Argon laser
photocoagulation in pregnancy,
prevent sub-retinal bleeding
 Karska-Basta I et al(2016)1 :

 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.
Referensi

 Lancu G, Coviltir V, et al. Particulaities of myopia in Pregnancy.

2013. Gineco Europe. Volume 9. no 34
 Omoti A E, et al. A Review of the Changes in Ophtalmic and Visual
System in Pregancy. 2008. African Journal of Reproductive Health.
Volume 12 no 3.
 Petrovic O, et al. Myopia and Delivery, should mode of delivery
influenced by moderate and high myopia? 2009. Gynaecol
Perinatol volme 18 no 1.