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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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Abstract
PURPOSE OF REVIEW The aim of this study was to summarize common eye changes that may occur during pregnancy, and how pregnancy may affect preexisting eye conditions such as glaucoma and diabetic retinopathy. Challenges and complexities surrounding the treatment of these eye conditions during pregnancy are also highlighted. RECENT FINDINGS Refractive changes are common and may persist in the postpartum in patients with keratoconus. Although new medical and surgical glaucoma treatments are available, their safety in pregnancy is unknown. Limited use of topical and systemic glaucoma therapies is recommended, with a preference for selective laser trabeculoplasty as first line treatment in appropriate cases. The impact of pregnancy on diabetic retinopathy remains unclear. Although anti-vascular endothelial growth factor agents are first-line treatment for sight-threatening diabetic retinopathy, their effect on the developing foetus remains unknown and are therefore best avoided in the first and second trimesters. Noninfectious uveitis tends to become less active during pregnancy, allowing the potential tapering of systemic therapy and the use of local topical or injected corticosteroid treatment for active disease as required. SUMMARY Significant changes can occur to the eye during pregnancy, wherein the optimal treatment for many ocular conditions remains uncertain, highlighting the need for further research to develop clear recommendations that best balance the need to preserve the mother's sight, and the health of the developing foetus. The need for preconception planning, and collaborative multidisciplinary care between the obstetrician, physician, ophthalmologist and paediatrician is paramount.
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Affiliation(s)
- Edmund W C Khong
- Department of Surgery, Central Clinical School, Monash University
- Centre for Eye Research Australia, University of Melbourne
| | - Helen H L Chan
- Royal Victorian Eye and Ear Hospital
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria
| | - Stephanie L Watson
- Save Sight Institute, Sydney Medical School, University of Sydney
- Corneal Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Lyndell L Lim
- Centre for Eye Research Australia, University of Melbourne
- Royal Victorian Eye and Ear Hospital
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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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Safety and efficacy of bilateral simultaneous XEN implant surgery: a pilot study. Int Ophthalmol 2021; 41:859-866. [PMID: 33387110 DOI: 10.1007/s10792-020-01640-w] [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] [Received: 04/16/2020] [Accepted: 10/29/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the bilateral simultaneous XEN (BISIXEN) surgery in open-angle glaucoma patients. METHODS Retrospective analysis of a prospective data base conducted on uncontrolled glaucoma patients who underwent BISIXEN surgery. Primary endpoint measure was the incidence of sight-threatening complications. Secondary endpoints included intraocular pressure (IOP) reduction and in number of required antiglaucoma medications. RESULTS Ten patients (20 eyes) were included in the analysis. Median (95% confidence interval) follow-up was 12.0 (7.0-12.0) months, with 14 eyes having a follow-up of 12 months. No sight-threatening complications, such as endophthalmitis, retinal detachment, corneal decompensation, or intraocular hemorrhages were observed in any eye of study sample. Mean IOP decreased significantly from 25.2 (21.5-28.9) mm Hg at baseline to 15.1 (13.4-16.8) mm Hg at the last follow-up visit (p = 0.0001). Mean number of antiglaucoma medications was significantly reduced from 2.9 (2.5 to 3.3) drugs at baseline to 0.40 (0.00-0.70) at the end of the study (p < 0.0001). At the last study visit, 14 (70.0%) eyes had an IOP ≥ 6 and ≤ 18 mm Hg without treatment. Two eyes needed surgical revision and three ones needed a new glaucoma surgery: two underwent Ahmed valves (one eye with aniridia and the other previously operated on) and one underwent non-penetrating deep sclerectomy. CONCLUSIONS Bilateral simultaneous XEN implantation may be a feasible strategy in those patients with high anesthetic risk.
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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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Results of fluorouracil-augmented Xen45 implantation in primary open-angle and pseudoexfoliation glaucoma. Int Ophthalmol 2020; 41:945-955. [PMID: 33180281 DOI: 10.1007/s10792-020-01650-8] [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: 04/14/2020] [Accepted: 10/29/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE To report the effectiveness and safety of 5-fluorouracil (5-FU)-augmented Xen45 implantation in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG). METHODS This single-center, retrospective chart review study included 29 eyes that underwent 5-FU-augmented Xen45 implantation. Main outcome measures were intraocular pressure (IOP) levels and number of glaucoma medications. Surgical success was defined as IOP ≤ 21 mmHg and ≥ 20% reduction from preoperative levels without (complete success) or with (qualified success) glaucoma medications and without further glaucoma surgery at last follow-up. All postoperative interventions and complications were also noted. RESULTS The mean age of the patients was 67.5 ± 10.3 years, and the mean follow-up time was 23.2 ± 12.6 months. Mean IOP was 24.5 ± 8.7 mmHg and decreased by 30.2% at 12 months, 24.9% at 24 months, and 31.7% at final visit (p < 0.001, p = 0.006, p > 0.001, respectively). Mean number of glaucoma medications decreased from 2.83 preoperatively to 0.71 at 12 months, 0.87 at 24 months, and 0.86 at final visit (p < 0.001). At final visit, the complete success rate was 48.3%, qualified success rate was 69%, and 62.1% of the eyes were free of glaucoma medications. Needling was performed in 7 eyes (24%). Adverse events included choroidal detachment in 5 eyes, hyphema in 2 eyes, and endophthalmitis in 1 eye. CONCLUSION 5-FU-augmented Xen45 implantation in POAG and PEXG patients provided safe and effective IOP lowering with significant reduction of glaucoma medications up to 3 years.
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Klug E, Solá-Del Valle D. Bilateral XEN Gel Stent Implantation in Juvenile-Onset Open-Angle Glaucoma. Case Rep Ophthalmol 2020; 11:336-341. [PMID: 32884547 PMCID: PMC7443652 DOI: 10.1159/000508391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/04/2020] [Indexed: 11/19/2022] Open
Abstract
The purpose of the current case is to report the successful management of juvenile-onset open-angle glaucoma with bilateral XEN Gel Stent (Allegran Inc., Irvine, CA) implantation in a patient first diagnosed during pregnancy with co-existing dysautonomia. Treatment with the XEN Gel Stent provided dramatic reductions in intraocular pressure (IOP), and glaucoma medications sustained up to 23 months postoperatively. The success of this case may suggest that this minimally invasive procedure could be an effective treatment option for younger patients who require substantial reductions in IOP and glaucoma medication burden.
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Affiliation(s)
- Emma Klug
- Glaucoma Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - David Solá-Del Valle
- Glaucoma Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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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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