Delhi Journal of Ophthalmology

Glaucoma Management During Pregnancy and Lactation

Amrit Mandal,1 Anwara Mammel,1 Harman Preet Kaur,2 Manav Deep Singh,1 Shreya Gujral,1 Anuj kumar1
1Department of Ophthalmology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. R. M. L. Hospital, New Delhi, India
2Department. of Gynaecology and Obstetrics, Palika Maternity Hospital, Lodhi Colony, New Delhi, India

Editor-in-Chief, Delhi Journal of Ophthalmology, Dr R.P.Centre, AIIMS.


Corresponding Author:

Harman Preet Kaur (MBBS)
Department of Gynaecology and Obstetrics, Palika Maternity Hospital, Lodhi Colony, New Delhi, India
Email: drharmanpreetk@hotmail.com.


Received: 06-JUN-2020 Accepted: 13-AUG-2020 Published Online: 12-MAR-2021
DOI: https://dx.doi.org/10.7869/djo.615

Abstract
Glaucoma is a chronic, progressive disease of advancing age which is relatively uncommon in childbearing age. However, with increasing professionalism among women, late pregnancies are becoming more common. This combined with early onset of ageing diseases in India, including glaucoma, more and more cases of glaucoma are being seen among pregnant women. Management of glaucoma in and around pregnancy is a unique challenge of balancing the risk of vision loss to the mother as against the potential harm to the foetus or newborn. During pregnancy, there is physiological reduction in intraocular pressure (IOP). However, some women with pre-existing glaucoma have elevated IOP requiring enhanced medical treatment. 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 foetus, especially in 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 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.

Keywords :Pregnancy, Lactation, Glaucoma, Glaucoma In Pregnancy