Treatment of Open-angle Glaucoma in Pregnancy
Open-angle glaucoma in a pregnant patient presents a distinct clinical challenge: decisions about IOP-lowering therapy must weigh the risk of glaucoma progression in the mother against the safety of the developing fetus.
Clinical Scenario
Glaucoma medical management of the pregnant patient presents challenges with respect to balancing the risk of glaucoma progression against concerns for the safety of the fetus.
Clinical Goal
Maintain IOP control and prevent glaucoma progression in the mother.
Treatment Approach (Partial)
IOP-lowering therapy is adapted for the pregnant patient, with punctal occlusion emphasized; selected topical agents and procedural options are used where appropriate, while certain drug classes are generally avoided.
Full drug selection, sequencing, and monitoring details are in the complete protocol below.
References
DOI: 10.1016/j.ophtha.2025.12.029
- Glaucoma medical management of the pregnant patient presents challenges with respect to balancing the risk of glaucoma progression against concerns for the safety of the fetus.
- Punctal occlusion should be emphasized when caring for patients who are pregnant or nursing and using glaucoma drop therapy.
- Beta-blockers tend to be used during pregnancy because there is long-term experience with this drug class.
- Brimonidine has a Pregnancy Category B rating.
- Laser trabeculoplasty surgery may be considered as an alternative or adjunct to medical therapy in select patients during pregnancy and breastfeeding.
- In general, most ophthalmologists avoid the use of prostaglandins during pregnancy because of the theoretical risk of premature labor, but these medications may be considered for use in the breastfeeding mother.
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