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Editors Selection IGR 18-2

Medical treatment: Pregnancy and glaucoma

Comment by Sameh Mosaed on:

16906 Glaucoma management in pregnancy: a questionnaire survey, Vaideanu D; Fraser S, Eye, 2007; 21: 341-343

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This survey by Vaideanu and Fraser (269) underscores the lack of consensus among consultant ophthalmologists with regards to treatment of glaucoma during pregnancy. In this study, 605 questionnaires were sent out, with 208 (47%) returned. Of the respondents, only 26% had previously treated a pregnant patient with glaucoma. When asked what they had done in this setting, of those who had dealt with this previously, 71% continued the pre-pregnancy management, and when all respondents were asked what they would do in this clinical situation, a full 31% responded that they were unsure. These figures suggest that the majority of clinicians have little expertise in this circumstance, and that there is no widely accepted algorithm to consult when the situation arises.

Glaucoma during pregnancy is a relatively infrequent occurrence, and it is likely that clinicians who had not dealt with this previously were less likely to respond. Therefore, the 26% of respondents who had dealt with this previously may suggest a larger than true occurrence rate.

Also, when the respondents who stated what treatments they would use if they needed to lower IOP, 45% stated they would use a beta blocker, 33% would use a prostaglandin, and 22% would start with some other medication. These widely varying treatment plans highlight our current lack of a strategy with demonstrated safety and efficacy in this patient population. Since uncontrolled glaucoma in pregnancy is a relatively rare occurrence, large scale studies on the safety of various interventions are difficult to perform. Hence the treatment of these patients will likely continue to be a nebulous practice for clinicians.

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