Glaucoma Management During Pregnancy and Lactation
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Glaucoma, primarily a disease of the older population, may affect women of childbearing age. Management of glaucoma in and around pregnancy is a unique challenge of balancing the risk of vision loss to the mother against the potential harm to the fetus or newborn. During pregnancy, there is a physiological reduction in intraocular pressure (IOP). In some cases it can increase, necessitating enhanced medical, laser, or surgical intervention.

The only anti-glaucoma medication categorized in Category B is brimonidine, all others being in Category C.

Laser trabeculoplasty is an alternative treatment that can be performed in all trimesters.

In selected pregnant glaucoma patients with medically uncontrolled and progressive glaucoma, surgery with caution may lead to good outcomes for the patient with no additional risk for the fetus, especially in the second trimester.

Beta-blockers and carbonic anhydrase inhibitors are preferred for use during lactation when brimonidine is an absolute contraindication due to its ability to cross the blood-brain barrier.

Possible options for glaucoma management and their risks should be discussed with pregnant and lactating patients and optimum treatment given so as to prevent any further deterioration in progressive vision loss and quality of life.

Delhi Journal of Ophthalmology
Source: http://dx.doi.org/10.7869/djo.615
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