Therefore, these medications should be used with caution. But don't worry if glaucoma … Anesthesiology 1999;91:1159-1163. One observational study of 11 cases of women exposed to latanoprost during pregnancy revealed no evidence of adverse effects due to topical exposure on pregnancy or neonatal outcomes. 1984;97:292-295. These medications should be considered only after carefully balancing the potential dangers to the fetus or infant with the risk of worsening glaucoma in the mother. [22] A retrospective study of Argon laser trabeculoplasty reported that 60% of lasered patients had uncontrolled IOP and required glaucoma surgery within two years following ALT. Topical beta-blockers have been used in the treatment of glaucoma for the adult and pediatric populations. [8] Nonetheless, given the theoretical risk of premature delivery, prostaglandin analogues are not a choice for first-line medication in pregnancy. See specialist: Can have a discussion about topical meds since the choices are different during pregnancy. Oxford University Press Inc. Moore PA. It’s never been more important to look after your health, including your eyesight. The doses used produced an exposure that is 189 times higher than the exposure seen in humans following multiple ophthalmic doses. Concerning the use of beta-blockers in pregnancy, isolated case reports have described adverse effects of systemic therapy to include apnea, intrauterine growth retardation, neonatal depression at birth (low Apgar scores), postnatal hypoglycemia, and bradycardia. [18] Nasolacrimal occlusion is performed by using the fingertips to apply pressure over the puncta and canaliculi for 5 or more minutes to occlude nasolacrimal drainage. Clinical aqueous outflow. If glaucoma surgery is considered during pregnancy, special considerations should be taken regarding the use of antimetabolites, patient positioning, and the type of anesthesia administered. Intraocular pressure typically decreases during pregnancy. Category X drugs show strong evidence of birth defects. COVID-19 put a stop to glaucoma research. Second, the IOP-reducing effect of pregnancy may cause normal or near-normal tension measurements when the pregnant woman with glaucoma is initially … The use of antimetabolite agents for glaucoma surgery ought to be avoided in gravid patients because of the potential teratogenic effects.[31]. Ideally, a discussion of the treatment plan of a woman’s glaucoma should be initiated before pregnancy begins. [30]The risk of subconjunctival administration is not known. Animal reproduction studies have not been conducted with epinephrine. [3][4] Specifically, increased progesterone and relaxin levels may decrease intraocular pressure and increase the coefficient of facility of aqueous outflow during the menstrual cycle and pregnancy. Maternal physiology is altered such that plasma volume and cardiac output are greater, and peripheral vascular resistance is reduced, thus lowering blood pressure. Citalopram has been linked to a very small increased risk of problems for your unborn baby. Glaucoma surgery during pregnancy should be avoided, particularly in the first trimester when the risk of abortion and teratogenicity with anesthetics, sedative agents, and antimetabolites is highest. Brimonidine carries a Category B rating and appears as one of the safer glaucoma medications to use during pregnancy. The first systematic study of SSRIs use during pregnancy showed that women who have taken SSRIs while pregnant have healthy full birth-weight infants. The National Collaborative Perinatal Project reported no increase in major or minor fetal abnormalities in the infants of 1024 women exposed to acetazolamide at different stages of pregnancy, including 12 infants exposed during the first trimester. Supine position in second and third trimester gestation can induce profound systemic hypotension due to aortic and vena caval compression by the uterus. Late in the third trimester, brimonidine should be discontinued because it can induce central nervous system depression in newborns. If your glaucoma is mild and you have not had any vision loss, you may be able to go off all your medications and just have your eye pressure checked more frequently. However, minimal difference in IOP lowering has been noted for 0.25% timolol as compared to 0.5% timolol, and with 0.5% timolol dosed once daily, as compared to twice daily. 0 comment. The offspring were noted to have decreases in body weight gain, as well as a delay in postnatal development. Category A medications have strong evidence of safety based on human studies. Oral (taken in a tablet or pill) carbonic … This page was last modified on November 15, 2019, at 13:50. Atropine can affect fetal heart rate, though the effect may be less likely with ophthalmic dose.[25]. Selecting drugs for the pregnant dental patient. International Ophthalmologists contest rules, https://eyewiki.org/w/index.php?title=Glaucoma_management_in_pregnancy_and_post-partum&oldid=49855. Gillian DP, Stephen JH M. Hormonal influence in simple glaucoma. Lustgarten reported the use of pilocarpine (Ocusert) in a 35-year-old patient during the course of pregnancy without any harm to the fetus. The ophthalmic literature includes case reports of topical timolol use during pregnancy with and without adverse effects on the baby. [12] On the other hand, there were no fetal adverse effects in 12 pregnant women who used oral acetazolamide for idiopathic intracranial hypertension management. However, the study sample size was too small to evaluate the risk of uncommon conditions such as sacrococcygeal teratoma, which has an incidence of 1 in 35,000 to 40,000 live births. Improving the Therapeutic Index of Topically Applied Ocular Drugs. [25] Halothane and nitrous oxide are inhaled anesthesics that have been reported to result in growth retardation and congenital anomalies in animal studies. Beta blockers commonly used to treat glaucoma topically (e.g. Objective To better understand the course of glaucoma during pregnancy in women with preexisting disease.. Methods Retrospective case series of 28 eyes of 15 women with glaucoma followed up during pregnancy. Frishman et al reviewed the available literature on the use of systemic beta-blockers in pregnancy and concluded that beta- blockers are relatively safe during pregnancy. [29] There are no studies reporting the teratogenic effect of this drug in the human fetus, though the mechanism of action of the drug strongly suggests a possible teratogenic risk. Depending on the severity of their disease, young patients with glaucoma may be able to tolerate small increases in their intraocular pressure during the course of pregnancy. [29] Fetal heart rate monitoring is a good detector of fetal asphyxia during surgery. Beta-blockers are known to be present in breast milk and thus may have the potential of causing systemic side effects in the nursing infant. Acetazolamide and dorzolamide have a Pregnancy Category C rating. Patients at increased risk for open-angle glaucoma include blacks older than 40 years, whites older than 65 years, and persons with a family history of glaucoma or a personal history of diabetes or severe my… Nonetheless, this option should be discussed with women who choose to continue topical IOP-lowering therapy in and around pregnancy. Teratology 1988; 37: 335–342. Answered on Mar 9, 2013. However, the extent to which these IOP changes should be anticipated in women with pre-existing glaucoma is unclear. Prednisolone and methylprednisolone cross the placenta less than betamethasone and dexamethasone and may have less of an effect on the fetus. Wagenvoort et al described the presence of bradycardia and arrhythmia in an otherwise healthy fetus at 21 weeks of gestation whose mother was using topical timolol 0.5%. Passo MS, Palmer EA, Van Buskirk EM. Holmes LB, Kawanishi H, Munoz A. Acetazolamide:maternal toxicity, pattern of malformations,and litter effect. However, glaucoma management becomes complicated during pregnancy, secondary to the potential side effects of the medications to the fetus. These include cases of respiratory distress (in patients with underlying restrictive airway disease), bradycardia, heart failure, fatigue, and depression. In this way, the adverse effects of medications can be prevented during the first trimester, when most organogenesis is occurring. Milk samples obtained from the nursing mother demonstrated higher levels of timolol in the milk sample as compared to the plasma sample drawn at the same time. Nonselective alpha agonists such as epinephrine and dipivefrin (an epinephrine prodrug) are seldom, if ever, used in the treatment of pediatric glaucoma today due to their relatively modest IOP reduction, high risk of ocular side effects, and risk of systemic toxicity. Eye Meds Now Quick Ophthalmic Drug Search. [2] Potential mechanisms for this IOP reduction include greater aqueous outflow facility due to hormonal changes, decreased episcleral venous pressure from reduction of venous pressure in the upper limbs, and metabolic acidosis resulting from gestation. For all topical medications used in conjunction with glaucoma surgery, punctal occlusion and eyelid closure should be considered to decrease systemic absorption of the medication. Furthermore, beta-blockers can be secreted into breast milk and may cause similar effects in newborn infants. Several case reports describe the use of miotics for glaucoma during pregnancy. Calbert IP,Sheila MG. Ocular hypotensive effect of late pregnancy with and without high blood pressure. Managing Glaucoma During and After Pregnancy. The effect of reduced tear drainage on corneal and aqueous concentrations of topically applied fluorescein. When topical or oral carbonic anhydrase inhibitors are used, fetal growth retardation monitoring may be considered. However, 18% of the women demonstrated progressive visual field loss, while an additional 18% demonstrated IOP elevation without visual field progression. If you become pregnant while taking citalopram, speak to your doctor. Get help now: Ask doctors free. Another case report demonstrated the transplacental transfer of acetazolamide and its subsequent induction of electrolyte imbalance in a neonate. But it hasn’t stopped our fight against glaucoma. More commonly used glaucoma drugs in this class are the selective alpha‑2 agonists, which reduce IOP by suppressing aqueous production and are commercially available as brimonidine (0.1%, 0.15%, and 0.2%) and apraclonidine (0.5% and 1%). Survey of ophthalmology 2001;45:449-454. Epinephrine and apraclonidine hydrochloride have a Pregnancy Category C rating. Given the known role of prostaglandins in the labor process, it is not surprising that animal studies have revealed the increased risk of abortion or preterm delivery with the systemic administration of the various prostaglandin analogues. Mark A.R. Br J clin Pharmac 1984;17:599-600. May 2018. It should not be used during … [22] However, given the short time-frame of pregnancy, trabeculoplasty may still be considered in these patients.
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