Embarazo, lactancia y glaucoma

Abstract

The therapeutic management of glaucoma during pregnancy or lactation is a challenge. In the present work we have proposed to review the most relevant and current aspects of the subject. There are often patients with advanced maternal age and glaucoma where there is a higher risk of complications, both for the fetus and the mother, and the obstetrician is not always aware of this disease. It is the ophthalmologist who must weigh the risks and benefits of the different therapeutic options. The greatest fetal risk occurs during the first trimester of pregnancy and less than 20% of all drugs classified by the U.S. Food and Drug Administration (FDA) belong to the safest categories (A or B), with most topical antiglaucomatous drugs falling into category C, except for brimonidine (category B). In the last month of pregnancy the drugs pass through the placenta and reach the fetal circulation, potentially affecting the cardiac, respiratory and neurological systems. No antiglaucomatous drug currently has scientific evidence to support its complete safety for the fetus based on human studies. But there are new options, such as selective laser trabeculoplasty, which can be performed during pregnancy. Finally, this issue should be known and considered in order to evaluate each case individually.