Glaucoma during pregnancy and lactation

Abstract:

Glaucoma treatment during pregnancy and lactation represents the challenge to ophthalmologists in clinical practice. The risk of maternal vision loss and the potential harm of antiglaucoma drugs to the fetus and newborn should be assessed. Majority of glaucoma patients generally remain stable during pregnancy, as intraocular pressure values tend to be reduced during pregnancy due to hormonal fluctuations. However, the course of the disease may be variable. Due to legal and ethical issues, there is no science-based evidence about safety of anti-glaucoma drugs in pregnant and nursing patients. It is considered that most of these drugs have potential adverse effects on the fetus or breastfeeding infant. So, the aim of treatment of glaucoma is to decrease the use of medications as much as possible, especially during the first trimester of pregnancy. Ophthalmologists are usually limited to treating patients with brimonidine in first trimester of pregnancy, and with beta-blockers and carboanhydrase inhibitors in second and third trimester. Laser trabeculoplasty is an alternative option for reducing intraocular pressure. In case of medical need, glaucoma surgery can be performed with caution, avoiding the procedure in the first trimester of pregnancy. The treatment of glaucoma in pregnancy must be tailored to each individual patient, with a detailed discussion of options and potential risks. Pregnant women should be monitored closely for detecting changes in intraocular pressure, to prevent any further deterioration to the visual filed and the vision-related quality of life.

Key words:
glaucoma; laser trabeculoplasty; medications; nursing; pregnancy; surgery