Abstract: Ocular safety and delivery mode selection in highly myopic pregnant women have become important clinical issues. High myopia is characterized by pathological eyeball elongation, which mainly causes three types of fundus complications: lacquer cracks, retinoschisis, and choroidal neovascularization (CNV). Hormonal changes during pregnancy and intraocular pressure fluctuations induced by the Valsalva maneuver during delivery further increase the risk of retinal detachment and subretinal hemorrhage. Prenatal risk assessment can be conducted using fundus laser scanning, OCT/OCTA, and other imaging modalities. Based on these assessments, clinical decisions can be stratified as follows: vaginal delivery is relatively safe for women without active CNV and with well-controlled retinal breaks. Cesarean section is recommended for those with active macular CNV. Prophylactic laser photocoagulation can be administered when clinically indicated. This article reviews the ocular pathological alterations, delivery-related risks, prenatal assessment, and delivery decision-making strategies in highly myopic pregnant women to provide evidence for clinical management.

Key words: High myopia, Pregnancy, Vaginal delivery, Choroidal neovascularization