Pregnancy-associated bilateral central retinal vein occlusion and diabetic retinopathy: a case report and literature review

Bilateral central retinal vein occlusion (CRVO) is exceptionally rare in pregnancy. We report a rare case of bilateral CRVO with concomitant diabetic retinopathy (DR) and evaluate trimester-sensitive management. Case report and literature review. A 37-year-old female at 26 weeks gestation presented with bilateral CRVO, DR, and cystoid macular edema (CME). Management was initially conservative. At 37 weeks gestation, neovascularization and pre-hyaloid hemorrhage developed in the left eye, progressing to postpartum vitreous hemorrhage and vision loss (counting fingers). Postpartum intravitreal anti-VEGF resulted in CME resolution and full visual recovery to 20/20 bilaterally. Literature review identified only ten cases of pregnancy-associated retinal vein occlusion, with our patient representing one of only three well-documented bilateral cases. Pregnancy-associated bilateral CRVO is rare but carries significant risk. This case suggests that 20/20 recovery is achievable through trimester-sensitive management, prioritizing conservative care during pregnancy and delaying anti-VEGF treatment until postpartum to ensure maternal and fetal safety. Pregnancy-associated RVO requires trimester-sensitive management. Severe CRVO vision loss in pregnancy may fully reverse after delivery Deferring anti-VEGF treatment, where appropriate, until postpartum avoids fetal risk without harming vision