Glaucoma treatment in pregnancy and lactation: A literature review

Abstract

Introduction: Intraocular pressure (IOP) in pregnancy decreases slightly towards the 18th gestation week, however in pregnant patients with glaucoma or ocular hypertension the IOP could be variable and will not necessarily be reduced. Therefore, some pregnant women require potentially risky treatment for them and their fetuses. Objective: To describe the relevant ocular physiopathological changes, management options and possible adverse effects of treatment during pregnancy and lactation, in patients with associated glaucoma. Materials and methods: A literature review of publications was carried out from 2001 to 2021, considering the corresponding MeSH terms for glaucoma, pregnancy, lactation, and intraocular pressure (IOP). In a structured way, the information was extracted and synthesized. Results: It is increasingly common to identify pregnant patients with glaucoma. This condition can be treated with topical medications, but most of those are category C. The treatment option with selective laser trabeculoplasty seems to be a safe treatment, but the evidence is limited. Glaucoma surgery is an option in case of poor IOP control and visual function deterioration. The use of antimetabolites is fully contraindicated in this group of patients. During lactation, it is necessary to adjust topical medications, considering the conditions of the newborn. Conclusions: The approach to glaucoma in the pregnant patient requires a precise balance between IOP control to prevent visual damage in the pregnant/lactating female and the prevention of adverse effects in the fetus/newborn.

Keywords

• glaucoma
• intraocular pressure
• lactation
• pregnancy