Contact Lens & Anterior Eye 37 (2014) 447–450
Contents lists available at ScienceDirect
Contact Lens & Anterior Eye journal homepage: www.elsevier.com/locate/clae
Evaluation of anterior segment parameters during and after pregnancy Mustafa Atas¸ a , Necati Duru b,∗ , Döndü Melek Ulusoy a , Hasan Altınkaynak b , Zeynep Duru c , Gökhan Ac¸maz d , Fatma Kaya Atas¸ d , Gökmen Zararsız e a
Kayseri Education and Research Hospital, Department of Ophthalmology, Kayseri, Turkey Ankara Atatürk Education and Research Hospital, Department of Ophthalmology, Ankara, Turkey c Ankara Numune Education and Research Hospital, Department of Ophthalmology, Ankara, Turkey d Kayseri Education and Research Hospital, Department of Obstetrics and Gynecology, Kayseri, Turkey e Department of Statistics, Erciyes University, Kayseri, Turkey b
a r t i c l e
i n f o
Article history: Received 12 February 2014 Received in revised form 31 May 2014 Accepted 21 July 2014 Keywords: Pentacam Anterior segment parameters Cornea Pregnancy Anterior chamber depth
a b s t r a c t Purpose: To compare the anterior segment parameters during pregnancy and post-pregnancy. Materials and methods: Fifty-four healthy pregnant women in their third trimester with ages ranging from 18 to 38 years were included in the study. All of the patients underwent comprehensive ophthalmologic examinations, including refraction, anterior segment, and fundus examinations, intraocular pressure, and axial length measurements. In addition, anterior chamber angle, anterior chamber depth, anterior chamber volume, corneal volume, central corneal thickness, and keratometry values were measured by Pentacam Scheimpflug camera. All measurements were measured again 3 months after delivery. Results: The mean intraocular pressure, anterior chamber angle, anterior chamber depth, anterior chamber volume, corneal volume, central corneal thickness, and keratometry measurements were significantly different during pregnancy and post-pregnancy (p < 0.05 for all); however, the mean spherical refraction, cylindrical refraction, and axial length were not statistically significantly different during pregnancy and post-pregnancy (p > 0.05 for all). Conclusions: We found that there is an increase in the anterior chamber parameters, corneal volume, corneal thickness, and corneal curvature and a decrease in intraocular pressure in the third trimester. © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
1. Introduction During pregnancy, almost all organ systems go through physiological changes due to hormonal effects. One of the most important organs affected by these changes is the eyes [1]. These physiological changes that occur as a result of pregnancy are usually measurable in the third trimester when hormonal activity levels peak. However, these changes are transient because, several weeks postpartum, all hormonal activities return to their pre-pregnant state [2]. In previous studies, researchers have tried to define the physiological effects of pregnancy on the eyes. A drop in intraocular pressure (IOP), loss in the visual field, decreased corneal sensitivity, and increase in corneal thickness and curvature are some of the physiological changes [2–8]. A review of anterior segment parameters is very important in an ophthalmologic exam. Today, Pentacam, which uses Scheimpflug
technology, is used to analyze anterior segment parameters. Usability, fast recording modes, and the ability to measure quantitatively are the main advantages of Pentacam. Pentacam can be used to measure central corneal thickness (CCT), corneal volume (CV), corneal curvature (K1, K2), anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle (ACA) [9]. In the literature, there are some studies about the effect of pregnancy and the postpartum period on refractive values, CCT, K1, and K2 [5–7,10,11], but there are no studies that focus on CV and anterior chamber parameters (ACD, ACV, and ACA). In this study, our main goal is to investigate the effect of pregnancy on anterior segment parameters and the changes in anterior segment parameters in the postpartum period.
2. Materials and methods 2.1. Study population and design
∗ Corresponding author. Tel.: +90 5067296729. E-mail address: [email protected] (N. Duru).
This prospective study was performed in the Departments of Obstetrics, Gynecology, and Ophthalmology at Kayseri Education
http://dx.doi.org/10.1016/j.clae.2014.07.013 1367-0484/© 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
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M. Atas¸ et al. / Contact Lens & Anterior Eye 37 (2014) 447–450
Table 1 Comparison of anterior segment and other parameters during and after pregnancy. Variable
During pregnancy (n = 54)
ACD ACA ACV CCT CV K1 K2 IOP AL Spherical refraction Cylindrical refraction
3.03 40.71 177.98 539.85 61.41 42.98 43.87 13.39 23.07 −0.21 −0.69
± ± ± ± ± ± ± ± ± ± ±
0.27 4.73 30.27 33.38 3.18 1.67 1.69 2.93 0.73 0.85 1.03
3 months after delivery (n = 54) 2.96 39.63 169.98 535.69 60.86 42.91 43.79 15.35 23.06 −0.21 −0.68
± ± ± ± ± ± ± ± ± ± ±
0.25 5.00 29.66 34.95 3.31 1.69 1.76 2.76 0.72 0.87 1.01
Difference (%) −2.38 −2.58 −4.47 −0.79 −0.91 −0.16 −0.20 16.89 −0.02 −0.13 −0.06
± ± ± ± ± ± ± ± ± ± ±
2.22 6.40 4.40 1.22 1.52 0.41 0.49 18.26 0.67 0.33 0.49
p 0.05). A comparison of anterior segment parameters between during pregnancy and in the third month postpartum was performed by a paired t-test. Statistical significance was defined as a p value of 0.05.
Fig. 1. Distribution of anterior chamber depth during pregnancy and third postpartum month.
M. Atas¸ et al. / Contact Lens & Anterior Eye 37 (2014) 447–450
Fig. 2. Distribution of anterior chamber angle during pregnancy and third postpartum month.
ocular structures [2–7,15–19]. Weinreb et al. reported a 3% increase in corneal thickness in their study, in which they used ultrasonic pachymetry. These authors explained this increase by fluid retention in the body during pregnancy [5]. Efe et al. also reported an increase in corneal thickness in the second and third trimesters. Furthermore, these authors found that corneal thickness returns to its normal level 3 months after delivery [7]. Their explanation for this change in corneal structure is either due to a secondary effect of fluid retention all over the body on the cornea or the fact that the cornea is directly affected by the progesterone and estrogen receptors found in corneal stroma and endothelium. It is also thought that the corneal edema during pregnancy causes refractive changes [10,11,20,21]. A study by Pizzarello et al. showed an increase in myopia during pregnancy. However, refractive values returned to their normal levels after delivery [11]. In various studies, differences in refractive errors were found during and after pregnancy, however those differences were not statistically significant [6,20,21]. Changes in corneal curvature can also be seen during pregnancy, in addition to changes in corneal thickness. Increased levels of progesterone and estrogen increase collagenolytic activity, which, as a result, might cause corneal steepening [22–25]. Fluid retention also adds to this risk. A study by Kiely et al. showed that
449
the corneal curvature becomes more curved in the horizontal and vertical axes during the beginning of the menstrual cycle and flattens with ovulation [26]. Park et al. detected a corneal steepening in the second and third trimesters, but cornea returned to normal in the postpartum period [6]. In another study, Bilgihan et al. again found an increase in keratometry values of seven eyes of four pregnant keratokonus patients, attributed to hormonal changes [27]. We reviewed corneal parameters during the third trimester and 3 months after delivery. During pregnancy, the cornea was about 4 m thicker on average, in comparison with three months postpartum. This difference was found to be statistically significant. Again, the CV was higher during pregnancy in comparison with the third month postpartum; this difference was also statistically significant. In addition, there was a statistically significant decrease in keratometry values in the third month postpartum when compared with the pregnancy period. Refractive values were similar during pregnancy and during the postpartum period. One of the important changes during pregnancy pertains to IOP. It is known that IOP decreases, particularly in the second trimester, and this decrease continues to the postpartum period [28]. In pregnancy, this drop in IOP is thought to be due to increased uveoscleral outflow that is facilitated by hormonal changes. The main hormones that play a role in this process are progesterone and beta-human chorionic gonadotropin hormone [28]. Moreover, venous pressure drops in the upper extremities of pregnant women and this change influences the episcleral venous pressure as well [29]. Green et al. reported a decrease in IOP during pregnancy and a return to normal levels in the third month postpartum [30]. This change was thought to be due to increased outflow of aqueous humor because of the hormones. Paterson and Miller showed a correlation between increased progesterone levels in pregnancy and an increased outflow of aqueous humor [31]. Another hypothesis is that the increased progesterone levels show an antagonistic effect on glucocorticoid receptors and eliminate the endogenous steroids’ hypertensive effects [32]. In our study, pregnancy IOP levels were decreased and there was a 2 mmHg increase in the third month postpartum, which was statistically significant. During pregnancy, changes in anterior chamber parameters are expected due to both fluid retention in the body and increased aqueous humor outflow. However, there are no clear data pertaining to the effects of pregnancy on anterior chamber parameters. A study by Karatepe et al., which analyzed the effects of the menstrual cycle on anterior chamber parameters, reported that ACV and ACA do not change during the menstrual cycle but ACD is significantly higher in the 26th day of the cycle [33]. In our study, ACV, ACD, and ACA were significantly higher during pregnancy compared with the third month postpartum. In conclusion, we determined that there is an increase in ACV, ACD, ACA, CV, CCT, K1, and K2 in the third trimester of pregnancy. These changes are thought to be due to both intracellular and extracellular fluid retention, as well as the interaction of hormone receptors in ocular structures with the sex steroids. In diagnosis and follow-up of anterior segment pathologies, patients should be questioned about being pregnant or not and the fact that pregnancy can cause changes in anterior chamber parameters must be kept in mind. In addition, diseases that affect anterior segment parameters such as glaucoma and keratoconus have different prognoses during pregnancy and corneal interventions such as refractive surgery should be postponed until the postpartum stabilization period.
Conflict of interest Fig. 3. Distribution of anterior chamber volume during pregnancy and third postpartum month.
No author has a financial or proprietary interest in any material or method mentioned.
450
M. Atas¸ et al. / Contact Lens & Anterior Eye 37 (2014) 447–450
References [1] Kubica-Trzaska A, Karska-Basta I, Kobylarz J, Romanowska-Dixon B. Pregnancy and the eye. Klin Oczna 2008;110:401–4. [2] Qureshi IA. Measurements of intraocular pressure throughout the pregnancy in Pakistani women. Chin Med Sci J 1997;12:53–8. [3] Phillips CI, Gore SM. Ocular hypotensive effect of late pregnancy with and without high blood pressure. Br J Ophthalmol 1985;69:117–9. [4] Riss B, Riss P. Corneal sensitivity in pregnancy. Ophthalmologica 1981;183:57–62. [5] Weinreb RN, Lu A, Beeson C. Maternal corneal thickness during pregnancy. Am J Ophthalmol 1988;105:258–60. [6] Park SB, Lindahl KJ, Temnycky GO, Aquavella JV. The effect of pregnancy on corneal curvature. CLAO J 1992;18:256–9. [7] Efe YK, Ugurbas SC, Alpay A, Ugurbas SH. The course of corneal and intraocular pressure changes during pregnancy. Can J Ophthalmol 2012;47:150–4. [8] Sunness JS. The pregnant woman’s eye. Surv Ophthalmol 1988;32:219–38. [9] Rabsilber TM, Khoramnia R, Auffarth GU. Anterior chamber measurements using Pentacam rotating Scheimpflug camera. J Cataract Refract Surg 2006;32:456–9. [10] Sharma B, Rekha W, Sharma T, Downey G. Refractive issues in pregnancy. Aust NZ J Obstet Gynaecol 2006;46:186–8. [11] Pizzarello LD. Refractive changes in pregnancy. Graefes Arch Clin Exp Ophthlmol 2003;24:484–8. [12] Gupta PD, Johar Sr K, Nagpal K, Vasavada AR. Sex hormone receptors in the human eye. Surv Ophthalmol 2005;50:274–84. [13] Suzuki T, Kinoshita Y, Tachibana M, Matsushima Y, Kobayashi Y, Adachi W, et al. Expression of sex steroid hormone receptors in human cornea. Curr Eye Res 2001;22:28–33. [14] Wickham LA, Gao J, Toda I, Rocha EM, Ono M, Sullivan DA. Identification of androgen, estrogen and progesterone receptor mRNAs in the eye. Acta Ophthalmol Scand 2000;78:146–53. [15] Brauner SC, Chen TC, Hutchinson BT, Chang MA, Pasquale LR, Grosskreutz CL. The course of glaucoma during pregnancy: a retrospective case series. Arch Ophthalmol 2006;124:1089–94. [16] Qureshi IA, Xi XR, Yaqob T. The ocular hypotensive effect of late pregnancy is higher in multigravidae than in primigravidae. Graefes Arch Clin Exp Ophthalmol 2000;238:64–7. [17] Akar Y, Yucel I, Akar ME, Zorlu G, Ari ES. Effect of pregnancy on intraobserver and intertechnique agreement in intraocular pressure measurements. Ophthalmologica 2005;219:36–42.
[18] Barbazetto IA, Pizzarello LD. Ocular changes during pregnancy. Compr Ophthalmol Update 2007;8:155–67. [19] Dinn RB, Harris A, Marcus PS. Ocular changes in pregnancy. Obstet Gynecol Surv 2003;58:137–44. [20] Manges TD, Banaitia DA, Roth N, Yolton RL. Changes in optometric findings during pregnancy. Am J Optom Physiol Opt 1987;64:159–66. [21] Ebeigbe JA, Ebeigbe PN, Ighoroje A. Ocular changes in pregnant Nigerian women. Nigerian J Clin Pract 2012;15:298–301. [22] Spoerl E, Zubaty V, Raiskup-Wolf F, Pillunat LE. Oestrogen-induced changes in biomechanics in the cornea as a possible reason for keratectasia. Br J Ophthalmol 2007;91:1547–50. [23] Sato T, Ito A, Mori Y, Yamashita K, Hayakawa T, Nagase H. Hormonal regulation of collagenolysis in uterine cervical fibroblasts. Modulation of synthesis of procollagenase, prostromelysin and tissue inhibitor of metalloproteinases (TIMP) by progesterone and oestradiol-17 beta. Biochem J 1991;275: 645–50. [24] Suzuki T, Sullivan DA. Estrogen stimulation of proinflammatory cytokine and matrix metalloproteinase gene expression in human corneal epithelial cells. Cornea 2005;24:1004–9. [25] Harris Jr ED, Krane SM. Collagenases. N Engl J Med 1974;291:652–61. [26] Kiely PM, Carney LG, Smith G. Menstrual cycle variations of corneal topography and thickness. Am J Optom Physiol Opt 1983;60:822–9. [27] Bilgihan K, Hondur A, Sul S, Ozturk S. Pregnancy-induced progression of keratoconus. Cornea 2011;30:991–4. [28] Davis E. Dana reza pregnancy an deye. In: Albert D, Jakobiec FA, editors. Principles and practice of ophthalmology. Philadelphia: WB Saunders; 2000. p. 4767–84. [29] Wilke K. Episcleral venous pressure and pregnancy. Acta Ophthalmol Suppl 1975;125:40–1. [30] Green K, Phillips CI, Cheeks L, Slagle T. Aqueous humor flow rate and intraocular pressure during and after pregnancy. Ophthal Res 1988;20: 353–7. [31] Paterson G, Miller S. Hormonal influence in simple glaucoma. Br J Ophthalmol 1963;47:129–37. [32] Ziai N, Ory SJ, Khan AR, Brubaker RF. Beta-human chorionic gonadotropin, progesterone, and aqueous dynamics during pregnancy. Arch Ophthalmol 1994;112:801–6. [33] Karatepe A, Onay M, Egrilmez S, Yagcı A. Evaluation of the effects of menstrual cycle on anterior chamber parameters as measured with Pentacam. Turk J Ophthalmol 2013;43:15–8.
Contents lists available at ScienceDirect
Contact Lens & Anterior Eye journal homepage: www.elsevier.com/locate/clae
Evaluation of anterior segment parameters during and after pregnancy Mustafa Atas¸ a , Necati Duru b,∗ , Döndü Melek Ulusoy a , Hasan Altınkaynak b , Zeynep Duru c , Gökhan Ac¸maz d , Fatma Kaya Atas¸ d , Gökmen Zararsız e a
Kayseri Education and Research Hospital, Department of Ophthalmology, Kayseri, Turkey Ankara Atatürk Education and Research Hospital, Department of Ophthalmology, Ankara, Turkey c Ankara Numune Education and Research Hospital, Department of Ophthalmology, Ankara, Turkey d Kayseri Education and Research Hospital, Department of Obstetrics and Gynecology, Kayseri, Turkey e Department of Statistics, Erciyes University, Kayseri, Turkey b
a r t i c l e
i n f o
Article history: Received 12 February 2014 Received in revised form 31 May 2014 Accepted 21 July 2014 Keywords: Pentacam Anterior segment parameters Cornea Pregnancy Anterior chamber depth
a b s t r a c t Purpose: To compare the anterior segment parameters during pregnancy and post-pregnancy. Materials and methods: Fifty-four healthy pregnant women in their third trimester with ages ranging from 18 to 38 years were included in the study. All of the patients underwent comprehensive ophthalmologic examinations, including refraction, anterior segment, and fundus examinations, intraocular pressure, and axial length measurements. In addition, anterior chamber angle, anterior chamber depth, anterior chamber volume, corneal volume, central corneal thickness, and keratometry values were measured by Pentacam Scheimpflug camera. All measurements were measured again 3 months after delivery. Results: The mean intraocular pressure, anterior chamber angle, anterior chamber depth, anterior chamber volume, corneal volume, central corneal thickness, and keratometry measurements were significantly different during pregnancy and post-pregnancy (p < 0.05 for all); however, the mean spherical refraction, cylindrical refraction, and axial length were not statistically significantly different during pregnancy and post-pregnancy (p > 0.05 for all). Conclusions: We found that there is an increase in the anterior chamber parameters, corneal volume, corneal thickness, and corneal curvature and a decrease in intraocular pressure in the third trimester. © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
1. Introduction During pregnancy, almost all organ systems go through physiological changes due to hormonal effects. One of the most important organs affected by these changes is the eyes [1]. These physiological changes that occur as a result of pregnancy are usually measurable in the third trimester when hormonal activity levels peak. However, these changes are transient because, several weeks postpartum, all hormonal activities return to their pre-pregnant state [2]. In previous studies, researchers have tried to define the physiological effects of pregnancy on the eyes. A drop in intraocular pressure (IOP), loss in the visual field, decreased corneal sensitivity, and increase in corneal thickness and curvature are some of the physiological changes [2–8]. A review of anterior segment parameters is very important in an ophthalmologic exam. Today, Pentacam, which uses Scheimpflug
technology, is used to analyze anterior segment parameters. Usability, fast recording modes, and the ability to measure quantitatively are the main advantages of Pentacam. Pentacam can be used to measure central corneal thickness (CCT), corneal volume (CV), corneal curvature (K1, K2), anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle (ACA) [9]. In the literature, there are some studies about the effect of pregnancy and the postpartum period on refractive values, CCT, K1, and K2 [5–7,10,11], but there are no studies that focus on CV and anterior chamber parameters (ACD, ACV, and ACA). In this study, our main goal is to investigate the effect of pregnancy on anterior segment parameters and the changes in anterior segment parameters in the postpartum period.
2. Materials and methods 2.1. Study population and design
∗ Corresponding author. Tel.: +90 5067296729. E-mail address: [email protected] (N. Duru).
This prospective study was performed in the Departments of Obstetrics, Gynecology, and Ophthalmology at Kayseri Education
http://dx.doi.org/10.1016/j.clae.2014.07.013 1367-0484/© 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
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M. Atas¸ et al. / Contact Lens & Anterior Eye 37 (2014) 447–450
Table 1 Comparison of anterior segment and other parameters during and after pregnancy. Variable
During pregnancy (n = 54)
ACD ACA ACV CCT CV K1 K2 IOP AL Spherical refraction Cylindrical refraction
3.03 40.71 177.98 539.85 61.41 42.98 43.87 13.39 23.07 −0.21 −0.69
± ± ± ± ± ± ± ± ± ± ±
0.27 4.73 30.27 33.38 3.18 1.67 1.69 2.93 0.73 0.85 1.03
3 months after delivery (n = 54) 2.96 39.63 169.98 535.69 60.86 42.91 43.79 15.35 23.06 −0.21 −0.68
± ± ± ± ± ± ± ± ± ± ±
0.25 5.00 29.66 34.95 3.31 1.69 1.76 2.76 0.72 0.87 1.01
Difference (%) −2.38 −2.58 −4.47 −0.79 −0.91 −0.16 −0.20 16.89 −0.02 −0.13 −0.06
± ± ± ± ± ± ± ± ± ± ±
2.22 6.40 4.40 1.22 1.52 0.41 0.49 18.26 0.67 0.33 0.49
p 0.05). A comparison of anterior segment parameters between during pregnancy and in the third month postpartum was performed by a paired t-test. Statistical significance was defined as a p value of 0.05.
Fig. 1. Distribution of anterior chamber depth during pregnancy and third postpartum month.
M. Atas¸ et al. / Contact Lens & Anterior Eye 37 (2014) 447–450
Fig. 2. Distribution of anterior chamber angle during pregnancy and third postpartum month.
ocular structures [2–7,15–19]. Weinreb et al. reported a 3% increase in corneal thickness in their study, in which they used ultrasonic pachymetry. These authors explained this increase by fluid retention in the body during pregnancy [5]. Efe et al. also reported an increase in corneal thickness in the second and third trimesters. Furthermore, these authors found that corneal thickness returns to its normal level 3 months after delivery [7]. Their explanation for this change in corneal structure is either due to a secondary effect of fluid retention all over the body on the cornea or the fact that the cornea is directly affected by the progesterone and estrogen receptors found in corneal stroma and endothelium. It is also thought that the corneal edema during pregnancy causes refractive changes [10,11,20,21]. A study by Pizzarello et al. showed an increase in myopia during pregnancy. However, refractive values returned to their normal levels after delivery [11]. In various studies, differences in refractive errors were found during and after pregnancy, however those differences were not statistically significant [6,20,21]. Changes in corneal curvature can also be seen during pregnancy, in addition to changes in corneal thickness. Increased levels of progesterone and estrogen increase collagenolytic activity, which, as a result, might cause corneal steepening [22–25]. Fluid retention also adds to this risk. A study by Kiely et al. showed that
449
the corneal curvature becomes more curved in the horizontal and vertical axes during the beginning of the menstrual cycle and flattens with ovulation [26]. Park et al. detected a corneal steepening in the second and third trimesters, but cornea returned to normal in the postpartum period [6]. In another study, Bilgihan et al. again found an increase in keratometry values of seven eyes of four pregnant keratokonus patients, attributed to hormonal changes [27]. We reviewed corneal parameters during the third trimester and 3 months after delivery. During pregnancy, the cornea was about 4 m thicker on average, in comparison with three months postpartum. This difference was found to be statistically significant. Again, the CV was higher during pregnancy in comparison with the third month postpartum; this difference was also statistically significant. In addition, there was a statistically significant decrease in keratometry values in the third month postpartum when compared with the pregnancy period. Refractive values were similar during pregnancy and during the postpartum period. One of the important changes during pregnancy pertains to IOP. It is known that IOP decreases, particularly in the second trimester, and this decrease continues to the postpartum period [28]. In pregnancy, this drop in IOP is thought to be due to increased uveoscleral outflow that is facilitated by hormonal changes. The main hormones that play a role in this process are progesterone and beta-human chorionic gonadotropin hormone [28]. Moreover, venous pressure drops in the upper extremities of pregnant women and this change influences the episcleral venous pressure as well [29]. Green et al. reported a decrease in IOP during pregnancy and a return to normal levels in the third month postpartum [30]. This change was thought to be due to increased outflow of aqueous humor because of the hormones. Paterson and Miller showed a correlation between increased progesterone levels in pregnancy and an increased outflow of aqueous humor [31]. Another hypothesis is that the increased progesterone levels show an antagonistic effect on glucocorticoid receptors and eliminate the endogenous steroids’ hypertensive effects [32]. In our study, pregnancy IOP levels were decreased and there was a 2 mmHg increase in the third month postpartum, which was statistically significant. During pregnancy, changes in anterior chamber parameters are expected due to both fluid retention in the body and increased aqueous humor outflow. However, there are no clear data pertaining to the effects of pregnancy on anterior chamber parameters. A study by Karatepe et al., which analyzed the effects of the menstrual cycle on anterior chamber parameters, reported that ACV and ACA do not change during the menstrual cycle but ACD is significantly higher in the 26th day of the cycle [33]. In our study, ACV, ACD, and ACA were significantly higher during pregnancy compared with the third month postpartum. In conclusion, we determined that there is an increase in ACV, ACD, ACA, CV, CCT, K1, and K2 in the third trimester of pregnancy. These changes are thought to be due to both intracellular and extracellular fluid retention, as well as the interaction of hormone receptors in ocular structures with the sex steroids. In diagnosis and follow-up of anterior segment pathologies, patients should be questioned about being pregnant or not and the fact that pregnancy can cause changes in anterior chamber parameters must be kept in mind. In addition, diseases that affect anterior segment parameters such as glaucoma and keratoconus have different prognoses during pregnancy and corneal interventions such as refractive surgery should be postponed until the postpartum stabilization period.
Conflict of interest Fig. 3. Distribution of anterior chamber volume during pregnancy and third postpartum month.
No author has a financial or proprietary interest in any material or method mentioned.
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M. Atas¸ et al. / Contact Lens & Anterior Eye 37 (2014) 447–450
References [1] Kubica-Trzaska A, Karska-Basta I, Kobylarz J, Romanowska-Dixon B. Pregnancy and the eye. Klin Oczna 2008;110:401–4. [2] Qureshi IA. Measurements of intraocular pressure throughout the pregnancy in Pakistani women. Chin Med Sci J 1997;12:53–8. [3] Phillips CI, Gore SM. Ocular hypotensive effect of late pregnancy with and without high blood pressure. Br J Ophthalmol 1985;69:117–9. [4] Riss B, Riss P. Corneal sensitivity in pregnancy. Ophthalmologica 1981;183:57–62. [5] Weinreb RN, Lu A, Beeson C. Maternal corneal thickness during pregnancy. Am J Ophthalmol 1988;105:258–60. [6] Park SB, Lindahl KJ, Temnycky GO, Aquavella JV. The effect of pregnancy on corneal curvature. CLAO J 1992;18:256–9. [7] Efe YK, Ugurbas SC, Alpay A, Ugurbas SH. The course of corneal and intraocular pressure changes during pregnancy. Can J Ophthalmol 2012;47:150–4. [8] Sunness JS. The pregnant woman’s eye. Surv Ophthalmol 1988;32:219–38. [9] Rabsilber TM, Khoramnia R, Auffarth GU. Anterior chamber measurements using Pentacam rotating Scheimpflug camera. J Cataract Refract Surg 2006;32:456–9. [10] Sharma B, Rekha W, Sharma T, Downey G. Refractive issues in pregnancy. Aust NZ J Obstet Gynaecol 2006;46:186–8. [11] Pizzarello LD. Refractive changes in pregnancy. Graefes Arch Clin Exp Ophthlmol 2003;24:484–8. [12] Gupta PD, Johar Sr K, Nagpal K, Vasavada AR. Sex hormone receptors in the human eye. Surv Ophthalmol 2005;50:274–84. [13] Suzuki T, Kinoshita Y, Tachibana M, Matsushima Y, Kobayashi Y, Adachi W, et al. Expression of sex steroid hormone receptors in human cornea. Curr Eye Res 2001;22:28–33. [14] Wickham LA, Gao J, Toda I, Rocha EM, Ono M, Sullivan DA. Identification of androgen, estrogen and progesterone receptor mRNAs in the eye. Acta Ophthalmol Scand 2000;78:146–53. [15] Brauner SC, Chen TC, Hutchinson BT, Chang MA, Pasquale LR, Grosskreutz CL. The course of glaucoma during pregnancy: a retrospective case series. Arch Ophthalmol 2006;124:1089–94. [16] Qureshi IA, Xi XR, Yaqob T. The ocular hypotensive effect of late pregnancy is higher in multigravidae than in primigravidae. Graefes Arch Clin Exp Ophthalmol 2000;238:64–7. [17] Akar Y, Yucel I, Akar ME, Zorlu G, Ari ES. Effect of pregnancy on intraobserver and intertechnique agreement in intraocular pressure measurements. Ophthalmologica 2005;219:36–42.
[18] Barbazetto IA, Pizzarello LD. Ocular changes during pregnancy. Compr Ophthalmol Update 2007;8:155–67. [19] Dinn RB, Harris A, Marcus PS. Ocular changes in pregnancy. Obstet Gynecol Surv 2003;58:137–44. [20] Manges TD, Banaitia DA, Roth N, Yolton RL. Changes in optometric findings during pregnancy. Am J Optom Physiol Opt 1987;64:159–66. [21] Ebeigbe JA, Ebeigbe PN, Ighoroje A. Ocular changes in pregnant Nigerian women. Nigerian J Clin Pract 2012;15:298–301. [22] Spoerl E, Zubaty V, Raiskup-Wolf F, Pillunat LE. Oestrogen-induced changes in biomechanics in the cornea as a possible reason for keratectasia. Br J Ophthalmol 2007;91:1547–50. [23] Sato T, Ito A, Mori Y, Yamashita K, Hayakawa T, Nagase H. Hormonal regulation of collagenolysis in uterine cervical fibroblasts. Modulation of synthesis of procollagenase, prostromelysin and tissue inhibitor of metalloproteinases (TIMP) by progesterone and oestradiol-17 beta. Biochem J 1991;275: 645–50. [24] Suzuki T, Sullivan DA. Estrogen stimulation of proinflammatory cytokine and matrix metalloproteinase gene expression in human corneal epithelial cells. Cornea 2005;24:1004–9. [25] Harris Jr ED, Krane SM. Collagenases. N Engl J Med 1974;291:652–61. [26] Kiely PM, Carney LG, Smith G. Menstrual cycle variations of corneal topography and thickness. Am J Optom Physiol Opt 1983;60:822–9. [27] Bilgihan K, Hondur A, Sul S, Ozturk S. Pregnancy-induced progression of keratoconus. Cornea 2011;30:991–4. [28] Davis E. Dana reza pregnancy an deye. In: Albert D, Jakobiec FA, editors. Principles and practice of ophthalmology. Philadelphia: WB Saunders; 2000. p. 4767–84. [29] Wilke K. Episcleral venous pressure and pregnancy. Acta Ophthalmol Suppl 1975;125:40–1. [30] Green K, Phillips CI, Cheeks L, Slagle T. Aqueous humor flow rate and intraocular pressure during and after pregnancy. Ophthal Res 1988;20: 353–7. [31] Paterson G, Miller S. Hormonal influence in simple glaucoma. Br J Ophthalmol 1963;47:129–37. [32] Ziai N, Ory SJ, Khan AR, Brubaker RF. Beta-human chorionic gonadotropin, progesterone, and aqueous dynamics during pregnancy. Arch Ophthalmol 1994;112:801–6. [33] Karatepe A, Onay M, Egrilmez S, Yagcı A. Evaluation of the effects of menstrual cycle on anterior chamber parameters as measured with Pentacam. Turk J Ophthalmol 2013;43:15–8.
