A State-of-the-Art Review of Ophthalmological Indications for a Cesarean Section: Is There a Patient for Whom a Cesarean Section Is Really Indicated?

TL;DR

This paper reviews whether cesarean sections are medically necessary for specific eye conditions during pregnancy.

Contribution

The study identifies rare ophthalmic conditions where cesarean section might be indicated, highlighting a gap in evidence-based guidelines.

Findings

Only a limited number of rare ophthalmic conditions may justify an elective cesarean section.

Current evidence is insufficient, with no randomized controlled trials identified.

Elective cesarean sections should be reserved for cases with clear medical indications.

Abstract

Purpose: Our purpose was to review the current literature regarding ophthalmologic indications for cesarean section (CS). Methods: A literature search was conducted using MEDLINE, Embase, and the Cochrane Library from inception through October 2024. The databases were searched using the following keywords: “Caesarean section” OR “Caesarean section” OR “delivery” OR “pregnancy” AND “eyes” OR “eye disorders” OR “ocular disease” OR “diabetic retinopathy” OR “myopia” OR “retinal detachment” OR “glaucoma” OR “keratoconus”. Studies were considered eligible if they described pregnancy management in women affected by an eye disorder, with insight into the mode of delivery. Results: A total of 8383 results were identified, including only 1 specific guideline and no randomized controlled trials. After a manual review, 38 manuscripts were selected for inclusion. Based on the available evidence, an elective CS may be considered on a case-by-case basis in the presence of specific ophthalmic conditions, such as high-grade myopia with subretinal neovascularization, proliferative diabetic retinopathy, advanced glaucoma, or advanced keratoconus. These conditions are rare among women of childbearing age. Conclusions: Currently, only a limited number of highly specific ophthalmic conditions may benefit from an elective CS. Considering the potential short- and long-term implications of a CS, and in line with the current World Health Organization recommendations, this surgical procedure should be reserved for cases with a clear indication. Given the paucity of data in the available literature, further prospective randomized controlled trials are necessary to enhance the quality of evidence.

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