Have colleagues experienced any pregnancyrelated adverse effects in patients taking glaucoma medication ? How do colleagues manage pregnant and lactating patients with glaucoma ?
Your comments are to be welcomed
With thanks
Not sure about during pregnancy, but during lactation a lot of info is here, our ophthalmologist was surprised that she does not need to tell women to stop breastfeeding.
https://www.halesmeds.com
none of the anti Glaucoma drugs have been tried in pregnant and lactating women. The safest will be the Laser Trabeculoplasty in elevated IOP.
During pregnancy:
all anti glaucoma drops have not been tested yet, more over some drugs like PG analouges are proved to be teratogenic. So all of them should be avoided. The option you have are
1-observation only during pregnancy if the case is mild and optic nerve damage is minimal
2- laser procedure if the case is moderate or if the patient showed deterioration with observation
3- surgery if the case is severe or advanced or the case showed deterioration after laser
During lactation:
You should not ask the patient to discontinue any antiglaucoma drop. Just learn her how to occlude her puncti for 2 minutes after instilling the drops to reduce systemic absorption
Most glaucoma drugs (i.e. β-blockers, PG analogues, CAIs and miotics) are classified as category C agents by the FDA, except for brimonidine which is in category B. So it is my first drug of choice, however, brimonidine is contraindicated for use in lactating mothers due to the risk of central nervous system depression in the newborn.
CAIs and b-blockers are certified by the American Academy of Pediatrics for use during lactation. So they can be used safely during nursing
Potential systemic side effects of eye drops could possibly be avoided, or minimized, by simple nasolacrimal occlusion and eyelids closure.
Due to lack of Meta-analyses and RCT in this aspect, the overall level of evidence for the risk to pregnant women is not known.
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