TREATMENT OF GLAUCOMA IN PREGNANCY

Glaucoma is a disorder of the eye characterised by loss of visual field and optic nerve damage. Usually glaucoma is associated with raised intra-ocular pressure but in some cases intra-ocular pressure may be within normal limits. Primary open-angle glaucoma (chronic simple glaucoma), the most common form, is asymptomatic and the patient may present with gradual visual field loss. Primary angle-closure glaucoma (acute closed-angle glaucoma) is a medical emergency occurring where the flow of aqueous humour into the anterior chamber is blocked.

Pharmacological treatments which reduce the intraocular pressure include ocular beta-adrenoceptor blocking drugs, prostaglandin analogues, miotics, sympathomimetics, and ocular and systemic carbonic anhydrase inhibitors.

There are little or no data on pregnancy outcomes following the use of these medications in pregnancy, therefore an evidence-based assessment of risk to the developing fetus with maternal exposure is not possible. However, untreated or under-treated glaucoma could potentially lead to maternal loss of vision, and as the potential benefits gained from treatment are likely to outweigh any unknown increase in risk to the fetus, optimum treatment of maternal glaucoma in pregnancy should be offered and this risk-benefit analysis discussed with the patient. 

Exposure to medications licensed in the UK for the treatment of glaucoma at any stage in pregnancy would not usually be regarded as medical grounds for termination. Due to the lack of data, reporting of exposure to UKTIS is advised. Additional fetal monitoring may be warranted in individual cases and where other risk factors which independently increase the risk of adverse pregnancy outcome are present. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.