Trabeculectomy in Pregnancy: Case Studies and Literature Review

Overview

Journal Indian J Ophthalmol

Specialty Ophthalmology

Date 2020 Feb 15

PMID 32056993

Citations 1

Authors

Nandini R Banad

Nikhil Choudhari

Siddharth Dikshit

Chandrasekhar Garudadri

Sirisha Senthil

Affiliations

Soon will be listed here.

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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References

Gupta V, Ghosh S, Sujeeth M, Chaudhary S, Gupta S, Chaurasia A . Selective laser trabeculoplasty for primary open-angle glaucoma patients younger than 40 years. Can J Ophthalmol. 2018; 53(1):81-85. DOI: 10.1016/j.jcjo.2017.07.023. View

Moore P . Selecting drugs for the pregnant dental patient. J Am Dent Assoc. 1998; 129(9):1281-6. DOI: 10.14219/jada.archive.1998.0425. View

Cillino S, Casuccio A, Di Pace F, Cagini C, Ferraro L, Cillino G . Biodegradable collagen matrix implant versus mitomycin-C in trabeculectomy: five-year follow-up. BMC Ophthalmol. 2016; 16:24. PMC: 4779569. DOI: 10.1186/s12886-016-0198-0. View

Shammas H, Milkie M, Yeo R . Topical and subconjunctival anesthesia for phacoemulsification: prospective study. J Cataract Refract Surg. 1998; 23(10):1577-80. DOI: 10.1016/s0886-3350(97)80032-6. View

Honjo M, Tanihara H . Impact of the clinical use of ROCK inhibitor on the pathogenesis and treatment of glaucoma. Jpn J Ophthalmol. 2018; 62(2):109-126. DOI: 10.1007/s10384-018-0566-9. View

Senthil S, Rao H, Babu J, Mandal A, Garudadri C . Comparison of outcomes of trabeculectomy with mitomycin C vs. ologen implant in primary glaucoma. Indian J Ophthalmol. 2013; 61(7):338-42. PMC: 3759104. DOI: 10.4103/0301-4738.109520. View

Coleman A, Mosaed S, Kamal D . Medical therapy in pregnancy. J Glaucoma. 2005; 14(5):414-6. DOI: 10.1097/01.ijg.0000177214.39244.da. View

Phillips C, Gore S . Ocular hypotensive effect of late pregnancy with and without high blood pressure. Br J Ophthalmol. 1985; 69(2):117-9. PMC: 1040536. DOI: 10.1136/bjo.69.2.117. View

Safran M, Robin A, POLLACK I . Argon laser trabeculoplasty in younger patients with primary open-angle glaucoma. Am J Ophthalmol. 1984; 97(3):292-5. DOI: 10.1016/0002-9394(84)90625-1. View

10.

Tanna A, Johnson M . Rho Kinase Inhibitors as a Novel Treatment for Glaucoma and Ocular Hypertension. Ophthalmology. 2018; 125(11):1741-1756. PMC: 6188806. DOI: 10.1016/j.ophtha.2018.04.040. View

11.

Razeghinejad Md M, Masoumpour Md M, Eghbal Md M, Myers Md J, Moster Md M . Glaucoma Surgery in Pregnancy: A Case Series and Literature Review. Iran J Med Sci. 2016; 41(5):437-45. PMC: 4967489. View

12.

Brauner S, Chen T, Hutchinson B, Chang M, Pasquale L, Grosskreutz C . The course of glaucoma during pregnancy: a retrospective case series. Arch Ophthalmol. 2006; 124(8):1089-94. DOI: 10.1001/archopht.124.8.1089. View

13.

Samples J, Meyer S . Use of ophthalmic medications in pregnant and nursing women. Am J Ophthalmol. 1988; 106(5):616-23. DOI: 10.1016/0002-9394(88)90597-1. View

14.

Pathania D, Senthil S, Rao H, Mandal A, Garudadari C . Outcomes of trabeculectomy in juvenile open angle glaucoma. Indian J Ophthalmol. 2013; 62(2):224-8. PMC: 4005241. DOI: 10.4103/0301-4738.101074. View

15.

Sethi H, Naik M, Gupta V . Management of glaucoma in pregnancy: risks or choices, a dilemma?. Int J Ophthalmol. 2016; 9(11):1684-1690. PMC: 5145101. DOI: 10.18240/ijo.2016.11.24. View

16.

Wide-Swensson D, Montal S, Ingemarsson I . How Swedish obstetricians manage hypertensive disorders in pregnancy. A questionnaire study. Acta Obstet Gynecol Scand. 1994; 73(8):619-24. DOI: 10.3109/00016349409013454. View

17.

Yoshida M, Okada E, Mizuki N, Kokaze A, Sekine Y, Onari K . Age-specific prevalence of open-angle glaucoma and its relationship to refraction among more than 60,000 asymptomatic Japanese subjects. J Clin Epidemiol. 2001; 54(11):1151-8. DOI: 10.1016/s0895-4356(01)00388-2. View

18.

Papaconstantinou D, Georgalas I, Karmiris E, Diagourtas A, Koutsandrea C, Ladas I . Trabeculectomy with OloGen versus trabeculectomy for the treatment of glaucoma: a pilot study. Acta Ophthalmol. 2009; 88(1):80-5. DOI: 10.1111/j.1755-3768.2009.01753.x. View

19.

Putterman G, Davidson J, Albert J . Lack of metabolism of timolol by ocular tissues. J Ocul Pharmacol. 1985; 1(3):287-96. DOI: 10.1089/jop.1985.1.287. View

20.

Johnson S, Martinez M, Freedman S . Management of glaucoma in pregnancy and lactation. Surv Ophthalmol. 2001; 45(5):449-54. DOI: 10.1016/s0039-6257(00)00209-5. View