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Madike R, Cugati S, Qin Q, Chen C. Pregnancy and the eye: What do we need to watch out for? A review. Clin Exp Ophthalmol 2024; 52:234-247. [PMID: 38214050 DOI: 10.1111/ceo.14346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
Pregnancy causes changes in all body systems, including the eye. The eye can undergo physiological and pathological changes in pregnancy. Some changes exacerbate pre-existing eye conditions while other conditions manifest for the first-time during pregnancy. Early recognition and management are essential to prevent sight threatening complications. In addition, some obstetric complications can be associated with ophthalmic signs. Prompt recognition of these eye findings may be life saving for both the mother and the foetus. The aim of this article is to present potential ocular complications in pregnancy and outline the appropriate management to preserve sight and maintain maternal and foetal safety. The safety of the use of common ophthalmological medications will also be discussed.
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Affiliation(s)
- Reema Madike
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Sudha Cugati
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, Modbury Hospital, South Australia Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Queena Qin
- Department of Ophthalmology, Modbury Hospital, South Australia Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Celia Chen
- Department of Ophthalmology, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
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2
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Kumar H, Singh S, Taneja S. Trabeculectomy in first trimester of pregnancy: A case report. Eur J Ophthalmol 2023; 33:NP49-NP52. [PMID: 36862594 DOI: 10.1177/11206721231158060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
PURPOSE Glaucoma management in pregnancy is a challenging task for the ophthalmologist. With limited studies due to ethical concerns, the exact management protocols are not well established. Surgery has been mentioned as an option in 2nd trimester and is avoided in 1st trimester due to the detrimental effect on organogenesis of fetus and the harmful effects of anaesthesia. METHODS A 26 year old woman with advanced glaucomatous damage underwent trabeculectomy without antifibrotic agent in first trimester of pregnancy. RESULTS The intraocular pressures (IOP) were well controlled during pregnancy with no need of addiitional antiglaucoma medications. She delivered a healthy baby at term with no congenital abnormality. CONCLUSION Trabeculectomy without antifibrotic agents can be done in first trimester of pregnancy in cases where IOP cannot be controlled with topical antiglaucoma drugs that are considered safe during this period. This is the first report in literature on trabeculectomy in first trimester of pregnancy.
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Affiliation(s)
- Harsh Kumar
- Glaucoma Services, Centre For Sight, New Delhi, India
| | - Swati Singh
- Glaucoma and Cataract Services, Centre for Sight, New Delhi, India
| | - Surbi Taneja
- Glaucoma and Cataract Services, Centre for Sight, New Delhi, India
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3
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Demarinis G, Tatti F, Taloni A, Giugliano AV, Panthagani J, Myerscough J, Peiretti E, Giannaccare G. Treatments for Ocular Diseases in Pregnancy and Breastfeeding: A Narrative Review. Pharmaceuticals (Basel) 2023; 16:1433. [PMID: 37895903 PMCID: PMC10610321 DOI: 10.3390/ph16101433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Pregnancy is a medical condition in which the physiological changes in the maternal body and the potential impact on the developing fetus require a cautious approach in terms of drug administration. Individual treatment, a thorough assessment of the extent of the disease, and a broad knowledge of the therapeutic options and different routes of administration of ophthalmic drugs are essential to ensure the best possible results while minimizing risks. Although there are currently several routes of administration of drugs for the treatment of eye diseases, even with topical administration, there is a certain amount of systemic absorption that must be taken into account. Despite continuous developments and advances in ophthalmic drugs, no updated data are available on their safety profile in these contexts. The purpose of this review is both to summarize the current information on the safety of ophthalmic treatments during pregnancy and lactation and to provide a practical guide to the ophthalmologist for the treatment of eye diseases while minimizing harm to the developing fetus and addressing maternal health needs.
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Affiliation(s)
- Giuseppe Demarinis
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Ospedale 48, 09124 Cagliari, Italy; (G.D.); (F.T.); (E.P.)
| | - Filippo Tatti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Ospedale 48, 09124 Cagliari, Italy; (G.D.); (F.T.); (E.P.)
| | - Andrea Taloni
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy;
| | | | - Jesse Panthagani
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea SS0 0RY, UK; (J.P.); (J.M.)
| | - James Myerscough
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea SS0 0RY, UK; (J.P.); (J.M.)
| | - Enrico Peiretti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Ospedale 48, 09124 Cagliari, Italy; (G.D.); (F.T.); (E.P.)
| | - Giuseppe Giannaccare
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Ospedale 48, 09124 Cagliari, Italy; (G.D.); (F.T.); (E.P.)
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy;
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Pol S, Upasani SD. Glaucoma in Pregnancy: Know What Next!! J Obstet Gynaecol India 2022; 72:366-368. [PMID: 36457432 PMCID: PMC9701255 DOI: 10.1007/s13224-021-01581-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/07/2021] [Indexed: 10/18/2022] Open
Abstract
Glaucoma is a complex disease which when encountered in pregnancy poses a challenge to the woman's obstetrician and her ophthalmologist. The dilemma arises while opting the line of management, either medical or surgical which requires balancing the clinical disease of the mother with the potential threat of therapy to the growing child. Such was our case an elderly primigravida 10 weeks of gestation who had an acute episode of angle closure glaucoma with diminishing vision, who was managed both medically (anti-glaucoma drugs) and surgically (trabeculectomy). She recovered with a normal IOP, improved vision and anomaly scan of the fetus showing a structurally normal fetus. Thus, the fear of uncertain drug teratogenicity should not discourage doctors from prescribing treatments when their expected benefits to the mother are thought to outweigh the risk to the fetus.
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Affiliation(s)
- Shraddha Pol
- Department of Obstetrics and Gynecology at Lokmanya, Tilak Municipal Medical College and General Hospital, Mumbai, India
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5
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Belkin A, Chen T, DeOliveria AR, Johnson SM, Ramulu PY, Buys YM. A Practical Guide to the Pregnant and Breastfeeding Patient with Glaucoma. Ophthalmol Glaucoma 2021; 3:79-89. [PMID: 32672600 DOI: 10.1016/j.ogla.2019.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Avner Belkin
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Teresa Chen
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | | | | | - Pradeep Y Ramulu
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, Ontario, Canada.
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6
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Arbabi A, Bao X, Shalaby WS, Razeghinejad R. Systemic side effects of glaucoma medications. Clin Exp Optom 2021; 105:157-165. [PMID: 34402741 DOI: 10.1080/08164622.2021.1964331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Glaucoma is a progressive loss of retinal ganglion cells leading to visual field loss. Lowering intraocular pressure is currently the only modifiable risk factor to slow glaucoma progression. Intraocular pressure-lowering options include topical and systemic medications, lasers, and surgical procedures. Glaucoma eye drops play a major role in treating this blinding disease. Similar to all medications, the glaucoma medications have their own adverse effects. The majority of glaucoma medications work by stimulating or inhibiting adrenergic, cholinergic, and prostaglandin receptors, which are distributed all over the body. Therefore, the glaucoma medications can affect organs other than the eye. This review will discuss the systemic adverse effects of carbonic anhydrase inhibitors, sympathomimetics, para-sympathomimetics, beta blockers, prostaglandin analogs, hyperosmotic agents, and novel glaucoma medications with a stress on pregnant patients, breastfeeding mothers, and paediatric patients.
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Affiliation(s)
- Amirmohsen Arbabi
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Xuan Bao
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China
| | - Wesam Shamseldin Shalaby
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Reza Razeghinejad
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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Anton N, Doroftei B, Ilie OD, Ciuntu RE, Bogdănici CM, Nechita-Dumitriu I. A Narrative Review of the Complex Relationship between Pregnancy and Eye Changes. Diagnostics (Basel) 2021; 11:1329. [PMID: 34441264 PMCID: PMC8394444 DOI: 10.3390/diagnostics11081329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 12/14/2022] Open
Abstract
Pregnancy is a condition often characterized by changes that occur in different parts of the body. Generally, the eyes suffer several changes during pregnancy that are usually transient but may become permanent at times. This may occur due to the release of placental hormones and those of maternal endocrine glands and fetal adrenal glands. Due to hormonal influences, physiological ocular changes during pregnancy have been shown in Caucasian women, so corneal sensitivity, refractive status, intraocular pressure, and visual acuity may change during pregnancy. Within this review, all studies that referred to physiological aspects and to changes of ocular pathology of pregnancy, the effect of the pregnancy on pre-existing (diabetic retinopathy, neuro-ophthalmic disorders) eye disorders, postpartum ocular changes, the intraocular pressure and the effect of hypotensive ophthalmic medicine during pregnancy, the connection between pregnancy and the neuro-ophthalmic pathology, as well as the role of anesthesia were analyzed.
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Affiliation(s)
- Nicoleta Anton
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (N.A.); (R.-E.C.); (C.M.B.); (I.N.-D.)
- Ophthalmology Clinic, “Saint Spiridon” Emergency Clinic Hospital, Independence Avenue, No. 1, 700111 Iasi, Romania
| | - Bogdan Doroftei
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Ovidiu-Dumitru Ilie
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University, Carol I Avenue, No. 20A, 700505 Iasi, Romania;
| | - Roxana-Elena Ciuntu
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (N.A.); (R.-E.C.); (C.M.B.); (I.N.-D.)
- Ophthalmology Clinic, “Saint Spiridon” Emergency Clinic Hospital, Independence Avenue, No. 1, 700111 Iasi, Romania
| | - Camelia Margareta Bogdănici
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (N.A.); (R.-E.C.); (C.M.B.); (I.N.-D.)
- Ophthalmology Clinic, “Saint Spiridon” Emergency Clinic Hospital, Independence Avenue, No. 1, 700111 Iasi, Romania
| | - Ionela Nechita-Dumitriu
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (N.A.); (R.-E.C.); (C.M.B.); (I.N.-D.)
- Ophthalmology Clinic, “Saint Spiridon” Emergency Clinic Hospital, Independence Avenue, No. 1, 700111 Iasi, Romania
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Razeghinejad MR, Nowroozzadeh MH. Anti‐glaucoma medication exposure in pregnancy: an observational study and literature review. Clin Exp Optom 2021; 93:458-65. [DOI: 10.1111/j.1444-0938.2010.00526.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- M Reza Razeghinejad
- Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
E‐mail:
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Banad NR, Choudhari N, Dikshit S, Garudadri C, Senthil S. Trabeculectomy in pregnancy: Case studies and literature review. Indian J Ophthalmol 2021; 68:420-426. [PMID: 32056993 PMCID: PMC7043156 DOI: 10.4103/ijo.ijo_638_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Glaucoma management during pregnancy is a challenge for the patient and doctor. During pregnancy, the intraocular pressure (IOP) decreases. However, some women with preexisting glaucoma have elevated IOP requiring enhanced medical treatment. Glaucoma refractory to medical treatment combined with disease progression may necessitate laser trabeculoplasty or surgical intervention. Surgery during pregnancy has potential risks for both the mother and fetus. The challenges include problems with anesthesia, positioning for surgery, difficulties in the surgical procedure, potential risk with antimetabolites, and concerns with the management of postoperative complications. We report two case scenarios that highlight the challenges associated with trabeculectomy in pregnant women and the modifications that can be adopted to improve safety and the efficacy of glaucoma filtering surgery during pregnancy.
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Affiliation(s)
- Nandini R Banad
- VST Center for Glaucoma Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Nikhil Choudhari
- VST Center for Glaucoma Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Siddharth Dikshit
- VST Center for Glaucoma Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Sirisha Senthil
- VST Center for Glaucoma Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Kumari R, Saha BC, Onkar A, Ambasta A, Kumari A. Management of glaucoma in pregnancy - balancing safety with efficacy. Ther Adv Ophthalmol 2021; 13:25158414211022876. [PMID: 34263134 PMCID: PMC8243098 DOI: 10.1177/25158414211022876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022] Open
Abstract
Glaucoma and pregnancy is an uncommon combination, but it constitutes a very challenging situation for the treating doctor. The challenge is not only controlling the intraocular pressure and preventing glaucoma progression in the mother, but also having to deal with her mental stress and anxiety regarding the safety of her child. The situation is further worsened by the lack of definite guidelines as to how to deal with such patients. Relative rarity of glaucoma in this population restricts any large prospective randomized clinical trials or any large systematic studies. Moreover, none of the existing anti-glaucoma medications is absolutely safe in pregnancy. Current practice patterns depend on some case reports, a few observational studies and a few animal studies that attempt at determining the safety and efficacy of the available medicines. These are then prescribed on the basis of their relative safety in any particular stage of pregnancy or lactation. Newer medications that were released recently in 2018, such as Vyzulta and Rhopressa, presently have limited data to support their safety for use during pregnancy. Laser trabeculoplasty, conventional filtration surgery (of course without anti-metabolites), and minimally invasive glaucoma surgery represent a few non-pharmacological management options. Surgical procedures such as trabeculectomy and tube-shunts or collagen matrix implants, and newer minimally invasive glaucoma surgery procedures such as the gelatin stents are currently being explored and may prove to be viable solutions for severe glaucoma during pregnancy, although they too have their own inherent drawbacks. Management of glaucoma during pregnancy and lactation requires careful consideration of the disease status, gestational stage, US Food and Drug Administration classification and guidelines, and potential benefits and limitations of the various therapeutic modalities. This review focuses on the importance of a multidisciplinary team approach, starting with preconception planning and counseling, determining the treatment options depending on the stage of glaucoma and of pregnancy, and emphasizes the involvement of the patients, their obstetrician, and pediatrician through active discussion regarding the various medical, laser, or surgical modalities currently available or under exploration for use during pregnancy and lactation. The ultimate aim is to achieve an optimal balance between the risks and benefits of any type of intervention, and to customize treatment on an individual basis in order to achieve the best outcomes for both mother and fetus.
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Affiliation(s)
- Rashmi Kumari
- Assistant Professor, Department of
Ophthalmology, Indira Gandhi Institute of Medical Sciences, House no. O/13,
Ashiyana Nagar Phase 1, Patna 800025, Bihar, India
| | - Bhawesh Chandra Saha
- Department of Ophthalmology, All India
Institute of Medical Sciences Patna, Patna, India
| | - Abhishek Onkar
- Department of Ophthalmology, All India
Institute of Medical Sciences Deoghar, Deoghar, India
| | - Anita Ambasta
- Regional Institute of Ophthalmology, Indira
Gandhi Institute of Medical Sciences, Patna, India
| | - Akanchha Kumari
- Department of Ophthalmology, All India
Institute of Medical Sciences Patna, Patna, India
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Gedde SJ, Vinod K, Wright MM, Muir KW, Lind JT, Chen PP, Li T, Mansberger SL. Primary Open-Angle Glaucoma Preferred Practice Pattern®. Ophthalmology 2021; 128:P71-P150. [DOI: 10.1016/j.ophtha.2020.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022] Open
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12
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Gedde SJ, Lind JT, Wright MM, Chen PP, Muir KW, Vinod K, Li T, Mansberger SL. Primary Open-Angle Glaucoma Suspect Preferred Practice Pattern®. Ophthalmology 2021; 128:P151-P192. [DOI: 10.1016/j.ophtha.2020.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022] Open
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13
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Hashimoto Y, Michihata N, Yamana H, Shigemi D, Morita K, Matsui H, Yasunaga H, Aihara M. Intraocular pressure-lowering medications during pregnancy and risk of neonatal adverse outcomes: a propensity score analysis using a large database. Br J Ophthalmol 2020; 105:1390-1394. [PMID: 32907812 DOI: 10.1136/bjophthalmol-2020-316198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/09/2020] [Accepted: 08/16/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND/AIMS To investigate the association between exposure to intraocular pressure (IOP)-lowering medications during pregnancy and neonatal adverse outcomes. METHODS This retrospective, cohort study used the JMDC Claims Database (JMDC, Tokyo, Japan), 2005-2018. We extracted data on pregnant women with glaucoma, including dispensation of (1) any IOP-lowering medications, (2) only prostaglandin analogues (PGs) and 3) only beta-blockers, during the first trimester. We compared frequency of congenital anomalies (CA), preterm birth (PB), low birth weight (LBW) and the composite outcome of these three measures, between the women with and without IOP-lowering medications. We calculated propensity scores (PSs) using logistic regression in which use of IOP-lowering medications was regressed against known confounders (disorders during pregnancy and other chronic comorbidities). We then conducted logistic regression in which neonatal adverse outcomes were regressed against use of IOP-lowering medications with adjustment for the PS. RESULTS We identified 826 eligible women, 91 (11%) of whom had received any IOP-lowering medications. CA occurred in 9.9% and 6.4%, PB in 2.2% and 4.5%, LBW in 9.9% and 6.0% and composite outcome in 17.6% and 13.3% of mothers with and without IOP-lowering medications, respectively. After adjustment for PS, IOP-lowering medications were not significantly associated with more frequent CA (adjusted OR (aOR), 1.43; 95% CI, 0.66 to 3.12), PB (aOR, 0.45; 95% CI, 0.10 to 1.97), LBW (aOR, 2.11; 95% CI, 0.98 to 4.57) or composite outcome (aOR, 1.40; 95% CI, 0.78 to 2.53). Results were similar regarding PGs only and beta-blockers only. CONCLUSIONS IOP-lowering medications during the first trimester were not significantly associated with increase in CA, PB or LBW.
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Affiliation(s)
- Yohei Hashimoto
- Department of Ophthalmology, The University of Tokyo, Bunkyo-ku,Japan .,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku,Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku,Japan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku,Japan
| | - Daisuke Shigemi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku,Japan
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku,Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku,Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku,Japan
| | - Makoto Aihara
- Department of Ophthalmology, The University of Tokyo, Bunkyo-ku,Japan
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14
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Abstract
Management of glaucoma during pregnancy represents a challenge for the physician. Important disease and patients' health decisions begin even before conception and continue throughout pregnancy and breastfeeding. The data on this topic is limited due to ethical and legal constraints and challenges of conducting large, prospective, and randomized clinical trials on this patient population. Our review suggests that individually, intraocular pressure is lower in a pregnant woman when compared with a nonpregnant woman. Importantly, the medical management of glaucoma during pregnancy poses special challenges due to the possibility of adverse effects of medications on the fetus and newborn. Laser trabeculoplasty and traditional filtration surgery, and minimally invasive glaucoma surgery, represent nondrug management options. Thus, managing glaucoma in pregnancy is a delicate balance between treatment to prevent damage to the optic nerve in the mother and avoidance of interventions potentially harmful to the fetus. This literature review of published individual and population-based studies was performed to explore current knowledge and guidelines in the management of glaucoma in pregnancy.
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15
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Pickering TD, Radhakrishnan S. Glaucoma and Pregnancy. CURRENT OPHTHALMOLOGY REPORTS 2020. [DOI: 10.1007/s40135-020-00239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
PURPOSE OF REVIEW Glaucoma management during pregnancy is a complex challenge, which requires balancing the clinical disease of the mother with the potential risks of therapy to the developing child. Because systematic studies are lacking in the pregnant population, this review aims to collect the array of available data from observational studies and case reports to provide the reader with guidance and context for the safety of glaucoma interventions during pregnancy. RECENT FINDINGS Surgical glaucoma is a rapidly expanding field with many new technologies and procedures. We review the surgical options for the gravid patient with reference to traditional procedures like trabeculectomy and tube-shunts, and newer MIGS procedures. When indicated, orphan trabeculectomy, or with collagen matrix implant may be a viable solution for severe glaucoma during pregnancy. Newer MIGS procedures such as the gelatin stent may also provide minimally invasive options for pregnant patients. Two new medications, Vyzulta and Rhopressa, were recently released in 2018 and have limited data to support their safety for use during pregnancy. SUMMARY The careful consideration of fetal health in the management of glaucoma during pregnancy is best done as a part of a multidisciplinary team including obstetrics and neonatology. When medication is necessary, steps to minimize systemic absorption should be employed. Surgical management should not be excluded for pregnant patients and may be considered before medical management in some cases to prevent fetal exposures and maternal harm.
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17
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Mehran NA, Sinha S, Razeghinejad R. New glaucoma medications: latanoprostene bunod, netarsudil, and fixed combination netarsudil-latanoprost. Eye (Lond) 2020; 34:72-88. [PMID: 31695162 PMCID: PMC7002400 DOI: 10.1038/s41433-019-0671-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022] Open
Abstract
Reduction of intraocular pressure is the only proven method to treat glaucoma. Initial treatment of glaucoma commonly involves using anti-glaucoma medications either as monotherapy or combination therapy. Studies on aqueous humour dynamics have contributed to our understanding of aqueous outflow mechanisms that have led to the discovery of new drugs. Three new drugs (latanoprostene bunod 0.24%, netarsudil 0.02%, and fixed combination netarsudil 0.02% -latanoprost 0.005%) have been introduced recently in the market with novel mechanisms of action. Latanoprostene bunod 0.024% is a nitric oxide-donating prostaglandin F2α analogue which increases the aqueous outflow both by uveoscleral and trabecular pathways. Netarsudil 0.02% is a potent Rho kinase/norepinephrine transporter inhibitor acting by increasing the trabecular outflow, decreasing the aqueous production, and possibly decreasing the episcleral venous pressure. This review highlights the role of these drugs in the management of glaucoma, with an overview of the major clinical trials on their efficacy, safety, and tolerability.
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Affiliation(s)
- Nikki A Mehran
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, United States
| | - Sapna Sinha
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, United States
| | - Reza Razeghinejad
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, United States.
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18
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Sinha S, Lee D, Kolomeyer NN, Myers JS, Razeghinejad R. Fixed combination netarsudil-latanoprost for the treatment of glaucoma and ocular hypertension. Expert Opin Pharmacother 2019; 21:39-45. [PMID: 31663782 DOI: 10.1080/14656566.2019.1685499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Reduction of intraocular pressure (IOP) is the only known modifiable risk factor for prevention and treatment of glaucoma. Rho-kinase (ROCK) inhibitors are a new class of glaucoma medications introduced recently with novel mechanisms of action and favorable safety profiles. Latanoprost, a common first line drug used for treatment of glaucoma, does not adequately control pressures in all cases. Addition of more than one anti-glaucoma medication affects patient compliance and adherence. Fixed-combination eye drops are combinations of two or more active drugs in a single dosage form, thus simplify dosing. New to this group is the fixed combination netarsudil- latanoprost (FCNL).Area covered: This review focuses on FCNL, its pharmacodynamics and pharmacokinetics. It also details the efficacy and safety of individual drugs compared to FCNL.Expert opinion: The combination of latanoprost and netarsudil is a potent medication and modulates all known targets for IOP reduction in a single drop and has been shown to be more effective than either drug alone. FCNL is an alternative for those with inadequately controlled IOP on a prostaglandin analog alone, as well as those for whom a simplified regimen is desirable, or those who are not good candidates for other classes of glaucoma medications.
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Affiliation(s)
- Sapna Sinha
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Daniel Lee
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
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Kalogeropoulos D, Sung VC, Paschopoulos M, Moschos MM, Panidis P, Kalogeropoulos C. The physiologic and pathologic effects of pregnancy on the human visual system. J OBSTET GYNAECOL 2019; 39:1037-1048. [PMID: 31190583 DOI: 10.1080/01443615.2019.1584891] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pregnancy is a normal state of physiological stress that induces significant changes in the human body, some of which can potentially affect the visual system. The pregnant state may exacerbate pre-existing ocular disorders (i.e. diabetic retinopathy or central serous retinopathy). Moreover, other systemic conditions related to pregnancy can induce ophthalmic disorders affecting the retina and the choroid, some of which are of acute nature. Increasing awareness and improving collaboration between ophthalmologists, obstetricians and internists can play a pivotal role in the management of complex conditions during pregnancy. Special attention should be given while prescribing medications or deciding about other diagnostic or therapeutic techniques. The purpose of this review is to summarise the physiologic and pathologic effects of pregnancy in the eyes, highlighting the most acute clinical entities that may be threatening for the vision or even the life of the mother and her baby.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Birmingham and Midland Eye Centre , Birmingham , United Kingdom.,Department of Ophthalmology, Faculty of Medicine School of Health Sciences, University of Ioannina , Ioannina , Greece
| | - Velota Ct Sung
- Birmingham and Midland Eye Centre , Birmingham , United Kingdom
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, Faculty of Medicine School of Health Sciences, University of Ioannina , Ioannina , Greece
| | - Marilita M Moschos
- First Department of Ophthalmology, General Hospital of Athens G. Gennimatas Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | | | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine School of Health Sciences, University of Ioannina , Ioannina , Greece
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Abstract
Glaucoma is a chronic, progressive disease of the optic nerve which is relatively uncommon in childbearing age; however, its management is a real challenge. Although the intraocular pressure decreases in pregnancy, many glaucoma patients continue to require treatment. In addition to the side effects, antiglaucoma medications on the mother, the possible side effects of drugs on the fetus must be taken into account. The only antiglaucoma medication categorized in Category B is brimonidine, and all others are in Category C. Most evidence on glaucoma medications in pregnancy comes from single case reports or animal studies with the limitations that these impose. Theoretically, glaucoma medications may damage the fetus; however, they may not have substantial clinical significance with routine dosages and no topical antiglaucoma agents have strong evidence of safety to the fetus based on the human studies. When discussing possible options for glaucoma management with the pregnant patient, it is important to emphasize the lack of definitive studies and the patient may be involved in the therapeutic decision-making process.
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Lusthaus JA, Goldberg I. Brimonidine and brinzolamide for treating glaucoma and ocular hypertension; a safety evaluation. Expert Opin Drug Saf 2017; 16:1071-1078. [DOI: 10.1080/14740338.2017.1346083] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jed Asher Lusthaus
- Discipline of Ophthalmology, University of Sydney, Sydney, Australia
- Glaucoma Unit, Sydney Eye Hospital, Sydney, Australia
| | - Ivan Goldberg
- Discipline of Ophthalmology, University of Sydney, Sydney, Australia
- Glaucoma Unit, Sydney Eye Hospital, Sydney, Australia
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European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition - Chapter 3: Treatment principles and options Supported by the EGS Foundation: Part 1: Foreword; Introduction; Glossary; Chapter 3 Treatment principles and options. Br J Ophthalmol 2017; 101:130-195. [PMID: 28559477 PMCID: PMC5583689 DOI: 10.1136/bjophthalmol-2016-egsguideline.003] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Evidence-Based Approaches to Glaucoma Management During Pregnancy and Lactation. CURRENT OPHTHALMOLOGY REPORTS 2016; 4:198-205. [PMID: 33384894 DOI: 10.1007/s40135-016-0112-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
With increasing maternal age in this decade, there is a parallel rise in the number of pregnant and lactating women affected by glaucoma worldwide. Understanding the diagnosis and management of glaucoma during pregnancy and lactation is essential to preventing blindness from glaucoma in this vulnerable population. This report provides a review of the current literature and offers effective strategies that will overcome the challenges in managing glaucoma during pregnancy and lactation. Practically, glaucoma management during pregnancy and lactation presents a unique challenge for the physician, as the benefit of any treatment must be weighed against the potential risks to the fetus. Prior to initiating or continuing treatment, the physician should be familiar with the various treatment options to manage intraocular pressure during pregnancy and lactation, including the safety of various anti-glaucoma medications as supported by the existing literature and based on the food and drug administration guidelines. A collaborative team effort between the ophthalmologist, obstetrician, and neonatologist in high-risk pregnancies is recommended to optimize care for the mother and fetus.
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Razeghinejad MR, Masoumpour M, Eghbal MH, Myers JS, Moster MR. Glaucoma Surgery in Pregnancy: A Case Series and Literature Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:437-45. [PMID: 27582594 PMCID: PMC4967489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Glaucoma management in pregnant patients is a real challenge, especially when the glaucoma is not controlled with medications. We report the results of 6 incisional glaucoma surgeries for the management of medically uncontrolled glaucoma patients during pregnancy. This retrospective, case series was conducted on the 6 eyes of 3pregnant patients with uncontrolled glaucoma using maximum tolerable medications. Details of the glaucoma surgical management of these patients as well as their postoperative care and pregnancy and clinical outcomes on longitudinal follow-up are discussed. All 3 patients had juvenile open-angle glaucoma and were on various anti-glaucoma medications, including oral acetazolamide. The first case described underwent trabeculectomy without antimetabolites in both eyes because of uncontrolled intraocular pressure with topical medications. The surgery was done with topical lidocaine jelly and subconjunctival lidocaine during the second and third trimesters. The second patient had an Ahmed valve implantation in both eyes during the second and third trimesters because of uncontrolled IOP with topical medications and no response to selective laser trabeculoplasty. Surgery was done with topical tetracaine and subconjunctival and sub-Tenon's lidocaine. The third case had a Baerveldt valve implantation under general anesthesia in the second trimester. In selected pregnant glaucoma patients with medically uncontrolled intraocular pressure threatening vision, incisional surgery may lead to good outcomes for the patient with no risk for the fetus.
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Affiliation(s)
- Mohammad Reza Razeghinejad
- Poostchi Eye Research Center, Poostchi Clinic, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Mohammad Reza Razeghinejad, MD; Department of Ophthalmology, Khlaili Hospital, Poostchi Clinic, Zand Street, Zip Code: 71936-16642, Shiraz, Iran Tel/Fax: +98 71 36291779
| | - Masoumeh Masoumpour
- Poostchi Eye Research Center, Poostchi Clinic, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Eghbal
- Department of Anesthesiology, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jonathan S. Myers
- Glaucoma Service, Wills Eye Institute, Jefferson Medical College, Philadelphia, USA
| | - Marlene R. Moster
- Glaucoma Service, Wills Eye Institute, Jefferson Medical College, Philadelphia, USA
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Abstract
INTRODUCTION It is generally believed that topical administration of eye drops safeguards against harmful systemic effects. However, about 80% of the drug in the ophthalmic products is systemically absorbed and the first-pass metabolism is avoided. Ophthalmic timolol is widely prescribed in the treatment of glaucoma either alone or in the combination eye drop products, many of which have been launched fairly recently. Ophthalmic timolol may cause serious adverse effects such as symptomatic bradycardia, various conduction disorders in the heart, orthostatic hypotension, syncope and falls. Areas covered: In this review we document a number of factors associated with the properties of ophthalmic timolol and specific features of a patient, which may jeopardize patient's cardiac safety even after topical treatment. Expert opinion: Plasma timolol levels are correlated with cardiovascular adverse effects in patients, since timolol is mainly metabolized by cytochrome P450 2D6 (CYP2D6) enzyme in the liver. Patients who are lacking the functional CYP2D6 or who are concomitantly using potent CYP2D6 inhibitor drugs (e.g. paroxetine or fluoxetine) or verapamil or other beta-blockers are at risk of getting serious cardiac adverse effects. Prior to treatment initiation, ECG should be always performed and CYP2D6 genotyping should be considered, if routinely available.
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Affiliation(s)
- Jukka Mäenpää
- a AstraZeneca, Research and Development, Patient Safety, Respiratory, Inflammation, Autoimmunity, Infections and Vaccines Therapeutic Area , Gothenburg , Sweden
| | - Olavi Pelkonen
- b Department of Pharmacology and Toxicology, Institute of Biomedicine , University of Oulu , Oulu , Finland
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Nice FJ, DeEugenio D, DiMino TA, Freeny IC, Rovnack MB, Gromelski JS. Medications and Breast-Feeding: A Guide for Pharmacists, Pharmacy Technicians, and other Healthcare Professionals Part II. J Pharm Technol 2016. [DOI: 10.1177/875512250402000205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To provide a guide for practicing pharmacists, pharmacy technicians, and other healthcare professionals so that they are able to counsel and advise breast-feeding mothers and fellow healthcare professionals on the safety and use of common cardiology and general medications during breast-feeding. Data Sources: Primary texts used by the breast-feeding community ( Medications and Mothers' Milk, Drugs in Pregnancy and Lactation, Drugs and Human Lactation) were searched, as well as Micromedex, MEDLINE, PubMed, EMBASE, and EMBASE2 (1984–February 2004). Study Selection/Data Extraction: Multiple sources were used wherever available to validate the data, and primary articles were used to verify all tertiary source information. Search terms included breast-feeding, lactation, nursing, and medications, as well as specific drug names. Data Synthesis: Concerns regarding medication use during breast-feeding have caused mothers to either discontinue nursing or not take necessary medications. Complete avoidance of medications or cessation of breast-feeding is often unnecessary. Although there are drugs that can be harmful to nursing infants, breast milk concentrations of most drugs are insufficient to cause any harm. Conclusions: Having objective and reliable information on medications enables pharmacists, pharmacy technicians, healthcare providers, and mothers to make educated decisions regarding drug therapy and breast-feeding.
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Affiliation(s)
- Frank J Nice
- FRANK J NICE MS MPA DPA CPHP, Assistant Director, Clinical Neurosciences Program (CNP), National Institutes of Health (NIH), Bethesda, MD
| | - Deborah DeEugenio
- DEBORAH DeEUGENIO PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Assistant Professor, School of Pharmacy, Temple University, Philadelphia, PA; Clinical Pharmacist, Jefferson Antithrombotics Therapy Service, Jefferson Heart Institute, Philadelphia
| | - Traci A DiMino
- TRACI A DiMINO PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Adverse Event Specialist, Global Safety Surveillance & Epidemiology, Wyeth, Collegeville, PA
| | - Ingrid C Freeny
- INGRID C FREENY PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Medical Student, Drexel University College of Medicine, Philadelphia
| | - Marissa B Rovnack
- MARISSA B ROVNACK PharmD, at time of writing, Pharmacy Student (Wilkes University), CNP, NIH; now, Clinical Staff Pharmacist, Lehigh Valley Hospital and Health Network, Allentown, PA
| | - Joseph S Gromelski
- JOSEPH S GROMELSKI PharmD, at time of writing, Pharmacy Student (Wilkes University), CNP, NIH; now, Pharmacist, Walmart, Baltimore, MD; Law Student, University of Maryland, Baltimore
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Yenerel NM, Küçümen RB. Pregnancy and the Eye. Turk J Ophthalmol 2015; 45:213-219. [PMID: 27800235 PMCID: PMC5082244 DOI: 10.4274/tjo.43815] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/17/2014] [Indexed: 12/01/2022] Open
Abstract
Pregnancy causes significant changes in all systems of the body. Although most of them are physiological, they may also lead to pathological consequences. The resulting pathological changes may occur for the first time or existing diseases affected by pregnancy can become more serious or change course. Diseases specific only to pregnancy may arise. Like all systems of the body, the visual system is also affected by pregnancy, developing a wide range of physiological and pathological changes. Knowing the ocular physiological changes and diagnosing eye diseases that may develop during pregnancy, and preventing and treating these diseases is crucial to ensure the baby's healthy development. Therefore, we have reviewed the conditions that an ophthalmologist should recognize, follow-up, and pay attention to during treatment and summarized them under the topic "pregnancy and the eye".
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Affiliation(s)
| | - Raciha Beril Küçümen
- Yeditepe University Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
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Cordero-Coma M, Salazar-Méndez R, Yilmaz T. Treatment of severe non-infectious uveitis in high-risk conditions (Part I): pregnancy and malignancies, management and safety issues. Expert Opin Drug Saf 2015; 14:1071-86. [DOI: 10.1517/14740338.2015.1044969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
A variety of changes in the eye can occur during pregnancy. These can be physiological, pathologic related to the pregnancy, or pathologic unrelated to the pregnancy. Pregnancy also can affect preexisting conditions. Pregnant women often discuss changes in their health first with their obstetrician; therefore, knowledge of common ophthalmic complaints during pregnancy is of particular concern for the practicing obstetrician. We reviewed the literature for ophthalmic and neuro-ophthalmic conditions that occur during pregnancy or in the postpartum period. Results are presented anatomically, first discussing general ophthalmologic conditions, then neuro-ophthalmic conditions follow. Effects of ocular medications on the fetus are reviewed.
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Chawla S, Chaudhary T, Aggarwal S, Maiti G, Jaiswal K, Yadav J. Ophthalmic considerations in pregnancy. Med J Armed Forces India 2013; 69:278-84. [PMID: 24600123 PMCID: PMC3862469 DOI: 10.1016/j.mjafi.2013.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 03/14/2013] [Indexed: 11/22/2022] Open
Abstract
The eyes are our window to the world and offer us an island of vision in the sea of darkness. Equally, the eyes are also a window to peep into what is going on in the milieu interior. Pregnancy is a natural state of physiological stress for the body. Each organ system of the body in a pregnant lady behaves at variation than in a non-pregnant state. A complex interplay exists between how the pregnancy affects the eye and how ocular physiology and pathology may lead to the modification of the management of pregnancy. Added to this is the effect of systemic conditions on the eye which gets modified by pregnancy. An awareness of the interaction of Ophthalmology and Obstetrics for the benefit of the mother and the child requires a basic understanding of these complex interactions. This article aims at presenting to the reader in a simplified and organized manner the common ophthalmic issues encountered in a pregnant woman, their management and the effect of various ophthalmic medication on the fetus.
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Affiliation(s)
- Sushil Chawla
- Classified Specialist (Obstetrics & Gynaecology), INHS Asvini, Colaba, Mumbai, India
| | - Tarun Chaudhary
- Classified Specialist (Ophthalmology), Air Force Central Medical Establishment, Subroto Park, New Delhi, India
| | - S. Aggarwal
- Classified Specialist (Ophthalmology), Air Force Central Medical Establishment, Subroto Park, New Delhi, India
| | - G.D. Maiti
- Senior Advisor (Obstetrics & Gynaecology), INHS Asvini, Colaba, Mumbai, India
| | | | - Jairam Yadav
- Resident (Obs & Gynae), INHS Asvini, Colaba, Mumbai, India
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Abstract
Pregnancy represents a real challenge to all body systems. Physiological changes can involve any of the body organs including the eye and visual system. The ocular effect of pregnancy involves a wide spectrum of physiologic and pathologic changes. The latter might be presenting for the first time during pregnancy such as corneal melting and corneal ectasia, or an already existing ocular pathologies that are modified by pregnancy such as diabetic retinopathy and glaucoma. In addition, pregnancy can affect vision through systemic disease that are either specific to the pregnant state itself such as the pre-eclampsia/eclampsia and Sheehan's syndrome, or systemic diseases that occur more frequently in relation to pregnancy such as Graves' disease, idiopathic intracranial hypertension, anti-phospholipid syndrome, and disseminated intravascular coagulation.
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Affiliation(s)
- Khawla Abu Samra
- Department of Ophthalmology, Ross Eye Institute, Buffalo, NY, USA
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Méndez-Hernández C. [Use of glaucoma medications during pregnancy and breastfeeding]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2012; 87:389-391. [PMID: 23121698 DOI: 10.1016/j.oftal.2012.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 10/08/2012] [Indexed: 06/01/2023]
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Mendez-Hernandez C, Garcia-Feijoo J, Saenz-Frances F, Santos-Bueso E, Martinez-de-la-Casa JM, Megias AV, Fernández-Vidal AM, Garcia-Sanchez J. Topical intraocular pressure therapy effects on pregnancy. Clin Ophthalmol 2012; 6:1629-32. [PMID: 23109799 PMCID: PMC3474270 DOI: 10.2147/opth.s36712] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the course of intraocular pressure (IOP), visual field progression, and adverse effects of antiglaucoma medication used during pregnancy. Methods Thirteen eyes of eight patients with glaucoma were examined. Their clinical records were reviewed to compare IOP, number of medications, and visual field indices (VFI) before, during, and after pregnancy using a two-tailed paired t-test. Results In seven (87.5%) of the eight patients, no disease progression was observed. IOP (mmHg) remained stable (baseline 17.3 ± 3.6; first trimester 17.4 ± 5.2, P = 0.930; second trimester 18.1 ± 4.7, P = 0.519; third trimester 20.2 ± 8.7, P = 0.344; and postpartum 21.5 ± 7.6, P = 0.136). The mean number of glaucoma treatments fell from 1.7 ± 0.52 before pregnancy to 0.83 ± 0.75 (P = 0.04) in the second and third trimesters. In one patient, IOP increased during pregnancy and there was further visual field loss. In the only patient kept on fixed combination timolol–dorzolamide therapy throughout pregnancy, labor was induced because of delayed intrauterine growth. Conclusions No changes in IOP and VFI were detected in most patients despite a reduction in the number of hypotensive agents required. Delayed intrauterine growth in one patient under fixed combination timolol–dorzolamide treatment was observed whereas no other adverse effects were detected.
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIMITTEL IN SCHWANGERSCHAFT UND STILLZEIT 2012. [PMCID: PMC7271212 DOI: 10.1016/b978-3-437-21203-1.10002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pregnancy and Glaucoma. Surv Ophthalmol 2011; 56:324-35. [DOI: 10.1016/j.survophthal.2010.11.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 11/25/2010] [Accepted: 11/30/2010] [Indexed: 11/18/2022]
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Razeghinejad MR, Sawchyn AK, Katz LJ. Fixed combinations of dorzolamide-timolol and brimonidine-timolol in the management of glaucoma. Expert Opin Pharmacother 2010; 11:959-68. [PMID: 20307220 DOI: 10.1517/14656561003667540] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD The emergence of fixed-combination drugs for the treatment of glaucoma has, to some extent, changed the medical management of glaucoma. The potential benefits of these drugs include a reduction in the total number of drops and preservatives instilled per day and improved patient comfort factors, which may contribute to better compliance. Combination medications may also improve therapeutic efficacy and play an important role in controlling medication cost. However, the fixed dosing may be a disadvantage in some cases. AREA COVERED IN THIS REVIEW This review describes the composition, pharmacokinetics, mode of action, efficacy, side effects, and safety profile of fixed-combination dorzolamide-timolol and fixed-combination brimonidine-timolol. WHAT THE READER WILL GAIN Understanding of the pros, cons, and safety profile of two FDA approved fixed-combination antiglaucoma medication. TAKE HOME MESSAGE Fixed-combination medications may be a reasonable adjunct to prostaglandins if a large drop in the intraocular pressure (IOP) is desired and adding only one medication is unlikely to reach the target IOP range. Both mentioned drugs are effective in reducing the IOP and further clinical studies will help identify differences in efficacy between the two. The clinician must make an individualized assessment of the medication's risk-benefit profile for each patient.
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Birkholz ES, Lee AG, Nerad JA, Lane KA, Bilyk JR. A Pregnant Pause. Surv Ophthalmol 2010; 55:162-8. [DOI: 10.1016/j.survophthal.2009.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022]
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Abstract
In the last decade topically applied prostaglandin F2alpha analogues (bimatoprost, latanoprost, travoprost and unoprostone) have become widely used as a means to reduce elevated intraocular pressure in patients with glaucoma and ocular hypertension. These molecules all have similar side-effect profiles, which include both side effects that occur frequently (e.g., conjunctiva hyperaemia, increase of iris pigmentation and eyelash changes) and rare adverse reactions (e.g., periocular pigmentation, damage to the blood-aqueous barrier and cystoid macular oedema). Conjunctiva hyperaemia, eyelash changes and cystoid macular oedema are reversible, but certain other side effects, such as increased iris pigmentation, are not. However, the systemic side-effect profile is favourable for all the prostaglandin analogues, and some of the local side effects are only of cosmetic significance. Numerous clinical studies suggest that discontinuing treatment with prostaglandin analogues on account of their side effects is rare in clinical practice.
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Affiliation(s)
- Gábor Holló
- Semmelweis University, Department of Ophthalmology, 1083. Budapest, Tömö u. 25-29, Hungary.
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIVERORDNUNG IN SCHWANGERSCHAFT UND STILLZEIT 2006. [PMCID: PMC7271219 DOI: 10.1016/b978-343721332-8.50004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND The management of glaucoma in a pregnant woman can pose a challenge for the ophthalmologist. The risks and benefits to the mother and foetus must be weighed. When it is decided that treatment is necessary, there is no consensus as to the safest treatment. This study was designed to garner the experiences and views of UK ophthalmologists with regard to this scenario. METHODS All consultant ophthalmologists in the UK were sent a questionnaire. They were asked if they had previous experience treating pregnant women with glaucoma, what management they had used, what management they would currently employ, and, if they were to use medical treatment, what would their first choice agent be. RESULTS A total of 282 out of 605 questionnaires were returned. Of the respondents, 26% had previously treated pregnant women with glaucoma. Most (71%) had continued with the therapy that the women were already on. In all, 34% had observed the situation and had not needed to treat. When asked what they would currently do in this scenario, 31% were unsure. A total of 40% would simply continue the prepregnancy treatment. A total of 45% of respondents, if they were to use medical treatment, would use beta-blockers, compared to 33% who would use prostaglandins. CONCLUSION Although it is thought to be a relatively rare clinical situation, over a quarter of our respondents had first hand experience of the management of glaucoma in pregnancy. Our results indicate some uncertainty about the optimal strategy. It is unlikely that trials will be performed and we suggest guidelines be produced using current knowledge and modified as evidence appears.
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Affiliation(s)
- D Vaideanu
- Sunderland Eye Infirmary, Sunderland, Tyne and Wear, UK
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Wertheim M, Broadway DC. Cyclodiode laser therapy to control intraocular pressure during pregnancy. Br J Ophthalmol 2002; 86:1318-9. [PMID: 12386103 PMCID: PMC1771359 DOI: 10.1136/bjo.86.11.1318] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bullimore MA. Glaucoma: optometry helps relieve the pressure. Optom Vis Sci 2002; 79:465-6. [PMID: 12199538 DOI: 10.1097/00006324-200208000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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