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Twin pregnancies, especially those in which the twins share one placenta but have separate amnion sacs (referred to monochorionic, diamniotic or Mo-di twins), are at risk for a number of complications. Most notable of these is twin-twin transfusion syndrome. This condition can result in fetal morbidity or intrauterine fetal demise but is also amenable to surgical intervention. Severe discordance in amniotic fluid volumes between each twin is the prenatal finding that highlights this diagnosis. Selective laser photocoagulation has greatly improved the survival of twins with this condition. With a posteriorly located placenta, laser ablation of the abnormal placenta vascular communications can be achieved with local anesthesia and maternal sedation. Anterior placenta location may present a challenge for uterine access that may require modification of the anesthetic technique.
Eales retinopathy associates peripheral retinal changes often described as "vasculitis", peripheral capillary nonperfusion (retinal ischemia), and retinal or optic nerve neovascularization (secondary to chronic retinal ischemia) resulting in vitreous hemorrhage and retinal detachment. Some of the syndromes are associated with lesions of the central nervous system, explaining why Eales retinopathy is considered an uncommon cause of stroke. It should be interpreted with caution because other entities may be the cause of the retinopathy and the central nervous system lesions. Various neurologic findings have been reported, including meningitis, encephalitis, cerebral vasculitis, brain infarctions and hemorrhages, cerebral venous thrombosis, and white matter diseases. The treatment of the retinopathy is limited to stimulating regression of neovascularization by applying laser photocoagulation to the nonperfused retina. Vitrectomy is indicated for nonclearing vitreous hemorrhage, extensive retinal neovascularization, epiretinal membrane, and traction retinal detachment.
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