She gave birth to a healthy child after an uneventful pregnancy

She gave birth to a healthy child after an uneventful pregnancy. LMP and gave birth at 38 weeks post LMP to a child that did not present any malformations. Conclusions This case series explains three women who underwent intravitreal ranibizumab treatment during pregnancy without showing any obstetric, embryofetal or neonatal complications. Introduction Anti-vascular endothelial growth factor (VEGF) molecules are commonly used in the treatment of choroidal neovascularization (CNV) and macular edema. VEGF plays a pivotal role during pregnancy, and systemic anti-VEGF administration during this period should thus be avoided. However, the fetal risk of intravitreal injection during pregnancy has not been evaluated to date. Ranibizumab is an anti-VEGF that has been utilized for over a decade. Here, we present three cases of patients treated with intravitreal ranibizumab during their pregnancy. Case reports Patient 1 A 26-year-old woman with a medical background of miscarriage suffered an exudative recurrence of idiopathic CNV, manifested by blurred vision and metamorphopsia. The best corrected visual acuity (BCVA) corresponded to a Snellen score of 5/10. Optical coherence tomography (OCT) revealed macular edema with serous macular neurosensory detachment (SMND). With the consent of the patient, an intravitreal ranibizumab injection was administered at 10 weeks post LMP. A second injection was administered at 21 weeks post LMP. Patient 2 A 31-year-old woman, pregnant via fertilization and suffering from myopic CNV of the right eye, presented an active recurrence with a clinical BVCA Snellen score of 5/10 and macular edema with SMND, revealed by OCT. She received an injection at 17 weeks post LMP. Patient 3 A 30-year-old woman with a complex obstetric history suffered a recurrence of a punctuate inner choroiditis of the right eye. BCVA obtained a Snellen value of 6/10. Macular OCT confirmed the recurrence of exudation. An intravitreal injection of ranibizumab was performed at 8 weeks post LMP. Cholestasis of pregnancy occurred at 35 weeks after LMP+6 days leading to an induced labor 2 weeks later. The three patients gave birth to healthy children at full term by post-vaginal delivery. No malformations or neonatal diseases were observed for the children, who were of normal fetal size and excess weight. Discussion Ranibizumab is usually a recombinant humanized monoclonal antibody fragment targeted against human VEGF-A. VEGF is usually expressed in multiple embryonic and fetal tissues during development, with the highest levels found in the lung, kidney, and heart. The increasing expression of this protein in placental tissues and fetal membranes throughout gestation suggests that it may play a role in embryofetal and placental development and in the maintenance of placental vascular function during pregnancy. VEGF may also be involved in the regulation of amniotic fluid volume and composition.1 In animal URAT1 inhibitor 1 studies, a low incidence of skeletal abnormalities and shortened supernumerary ribs was observed in monkey fetuses URAT1 inhibitor 1 after the pregnant mothers were treated with 1?mg/vision of ranibizumab. The 1?mg/vision dose resulted in serum levels of ranibizumab up to 13 occasions higher than the 149?kDa), its transplacental passage rate is likely much lower than that of bevacizumab due to the inability of the Fab fragment to cross the placenta. Intravenous bevacizumab has been shown to be embryotoxic and teratogenic when administered to rabbits, which present decreases in maternal and fetal body weights, an increased quantity of fetal resorptions and an increased incidence of fetal skeletal malformations.3 To the best of our knowledge, you will find no published cases of pregnant woman treated with ranibizumab injection during the first two trimesters of pregnancy. Two cases of ranibizumab treatment during the third trimester of pregnancy4, 5 concerned two 29-year-old women who gave birth URAT1 inhibitor 1 to healthy children after ranibizumab treatment for choroidal neovascularization. Nineteen cases of injections of bevacizumab Mouse monoclonal to CD147.TBM6 monoclonal reacts with basigin or neurothelin, a 50-60 kDa transmembrane glycoprotein, broadly expressed on cells of hematopoietic and non-hematopoietic origin. Neutrothelin is a blood-brain barrier-specific molecule. CD147 play a role in embryonal blood barrier development and a role in integrin-mediated adhesion in brain endothelia during pregnancy have been published,6 with complications occurring during the first month of pregnancy in five cases. Conclusion To the best of our knowledge, this is the first report around the absence of embryofetal abnormalities following intravitreal injections of ranibizumab performed in three pregnant women in.

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