• With keratoconus, do I need Caesarean delivery?


    Question:

    I am pregnant and have been previously diagnosed with keratoconus. My condition is managed with glasses only. My former optometrist mentioned Caesarian delivery is necessary for keratoconus patients due to intraocular pressure, but I can't find any research to support this. Is this true?


    Answer:

    There are a few published cases where keratoconus (cone-shaped cornea) patients have corneal damage from the increased intraocular pressure during vaginal delivery. However, this is extremely rare. In these isolated cases, there have often been other factors such as the use of topical steroids that may have contributed to the perforation (holes) of the cornea.

    When counseling patients with keratoconus, I’m most concerned about corneal perforation in those that have pre-existing areas of extreme corneal thinning. Each patient needs to be evaluated on a case-by-case basis. However, elective Caesarean section due to risk of corneal perforation should be rare.

    You should talk with both your obstetrician and your ophthalmologist to weigh the benefits of an elective Caesarean section (when babies are delivered by surgery, through an incision in mother’s abdomen) versus the risk of spontaneous perforation from keratoconus during vaginal delivery.


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