| Abstract [eng] |
The aim of this study is to summarize the current knowledge on the management of glaucoma in pregnant and breastfeeding patients by reviewing and evaluating disease prevalence, pathogenetic basis, disease prevalence, diagnostic features and treatment challenges. A structured narrative literature review was conducted, primarily selecting high quality scientific articles mainly from the past 10 years from PubMed, ScienceDirect, and Google Scholar databases, as well as evidence-based guidelines such as the 6th edition of the European Glaucoma Society guidelines. Glaucoma during pregnancy represents a complex clinical challenge that requires careful management to preserve maternal vision while minimizing risks to the developing fetus. Although many pregnant women experience a physiological reduction in intraocular pressure (IOP) due to hormonal, circulatory, and biomechanical changes, this effect is variable and cannot be relied upon to protect all patients, particularly those with pre-existing glaucoma. Risk factors such as age, ethnicity, family history, ocular anatomy, and systemic conditions may influence disease progression and require careful assessment before and during pregnancy. Monitoring glaucoma during pregnancy can be challenging. Physiological changes in the cornea may affect IOP measurements, and visual field testing can be less reliable due to fatigue or discomfort. Imaging tools such as optical coherence tomography (OCT) and fundus photography are safe and valuable for assessing the optic nerve and retinal structures, helping clinicians detect early progression. Treatment must be individualized and cautious. Topical medications, including beta-blockers and alpha-2 adrenergic agonists, are generally preferred first line, while prostaglandin analogues and systemic carbonic anhydrase inhibitors should be reserved for cases where benefits clearly outweigh fetal risks. Non-pharmacological strategies, such as lifestyle modifications and structured monitoring, are important adjuncts. Laser procedures, including selective laser trabeculoplasty (SLT) and laser peripheral iridotomy (LPI), can reduce medication dependence and are considered safe during pregnancy. For patients with progressive or vision-threatening glaucoma, surgical options may be required. Minimally invasive glaucoma surgery (MIGS) and trabeculectomy, performed with careful anesthesia management and preferably in the second trimester, can provide effective IOP control while limiting fetal exposure. Postoperative care, including the careful use of topical antibiotics, corticosteroids, and cycloplegic agents, is essential to maintain safety. Postpartum monitoring is critical, as sudden hormonal changes can cause rebound increases in IOP, requiring adjustment of medications during lactation. Overall, the management of glaucoma in pregnant and breastfeeding women requires a personalized, multidisciplinary, and evidence- based approach. Despite advances in diagnostics, medications, and surgical techniques, further research is needed to ensure optimal outcomes for both mother and child. |
