Mode of delivery in women at risk of rhegmatogenous retinal detachment: A systematic review

Background: Rhegmatogenous retinal detachment (RRD) is essentially a tear in the retina leading to vitreous humor accumulation behind it. Despite lacking guidelines contraindicating vaginal delivery for RRD risk, many doctors may recommend cesarean sections due to reported associations with Valsalva maneuver, prompting our study to assess delivery mode's relation to RRD and evaluate practice measures for at-risk pregnant women. In this context, performing cesarean sections can exacerbate healthcare costs, straining the healthcare system and highlighting the importance of evidence-based decision-making in obstetric care.
Methods: the search encompassed all literature designs in the following databases: Google Scholar, Cochrane, Scopus, and pubmed (n= 875). The keywords and search strategies were thoroughly documented and the final included studies were 14 following multiple screening processes.
This study included 14 studies with a total of 216 patients. The total number of deliveries was 264, including 10 from case reports. Of these, 136 were spontaneous vaginal deliveries, 7 were assisted vaginal deliveries, and 121 were cesarean sections.
The women had ophthalmic conditions such as a history of RRD, Stickler syndrome, high myopia, and lattice degeneration. A substantial portion of the studies reported no postpartum visual complications or fundal abnormalities following both delivery methods vaginal and caesarian. In retrospective analyses, recurrent RRD following VD and CS occurred at similar rates.
Conclusion: The study findings suggest that the method of delivery, whether spontaneous vaginal, assisted vaginal, or cesarean section, does not impact the occurrence of rhegmatogenous retinal detachment in individuals considered to be at high risk. It also calls for more research into the value and specific indications of prophylactic laser photocoagulation in such cases.