Treating glaucoma during pregnancy can be challenging, requiring a balance between managing the mother’s condition and weighing the potential risks to the developing child. Researchers recently suggested a multidisciplinary team that includes obstetrics and neonatology should counsel pregnant patients being treated for glaucoma and help monitor fetal health, especially since limited data exists regarding potential adverse events.

If medical management is necessary, a recent literature review published in Current Opinion in Opththalmology recommends clinicians take steps to reduce systemic absorption. They added that only two medications carry a historic FDA category B recommendation with inferred safety in humans from animal studies. They advise discontinuing medical therapy during the first eight weeks of gestation whenever possible, as this period is critical for major fetal organ development.

The team said clinicians should consider laser and surgical management, even before medical management in some cases, to prevent fetal exposure and maternal harm. They noted that traditional procedures, such as trabeculectomy and tube-shunts, are always options, as are newer minimally invasive glaucoma surgeries. When indicated, orphan trabeculectomy and collagen matrix implantation may be viable solutions for severe or progressive glaucoma during pregnancy, and the gelatin stent may also provide a minimally invasive option for pregnant patients.

“The management of the gravid patient with glaucoma entails consideration of both maternal disease severity and progression, and the potential adverse effects of therapeutic intervention on fetal growth and development,” the authors wrote in their paper. “Although no systematic studies are likely to ever exist in this population, observational case-control studies and case reports help to place the array of therapeutic options into some context of safety for use during pregnancy.”

Strelow B, Fleischman D. Glaucoma in pregnancy: an update. Curr Opin Ophthalmol. January 9, 2020. [Epub ahead of print].