# A comprehensive review of management modalities for glaucoma and intraocular hypertension during pregnancy

## TL;DR

This review explores how to manage glaucoma and high eye pressure during pregnancy, balancing maternal eye health with fetal safety.

## Contribution

The paper provides a comprehensive synthesis of current evidence on glaucoma management during pregnancy, including emerging minimally invasive surgical options.

## Key findings

- Pregnancy can cause intraocular pressure fluctuations influenced by factors like age, parity, and corneal thickness.
- Beta-blockers are commonly used, but punctal occlusion is advised to minimize systemic absorption.
- Minimally invasive glaucoma surgeries and laser treatments are emerging as viable options during pregnancy.

## Abstract

Glaucoma during pregnancy presents a complex clinical challenge, requiring a careful balance between effective intraocular pressure (IOP) control and fetal safety.

This review examines the ocular changes that occur during pregnancy and their implications for glaucoma progression and management.

It synthesizes current evidence on IOP fluctuations, disease progression risks, and the safety profiles of pharmacologic, laser, and surgical interventions. Studies were included if they met the following criteria: (1) involved pregnant women diagnosed with glaucoma or ocular hypertension; (2) evaluated medical, laser, or surgical management strategies during pregnancy; and (3) reported outcomes related to intraocular pressure control, optic nerve evaluation, or visual field assessment. Studies focusing exclusively on other ocular complications of pregnancy were excluded. Particular attention is given to emerging trends in minimally invasive glaucoma surgeries (MIGS), diagnostic innovations, and pharmacotherapies tailored to the gestational period. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework was used to guide methodological rigor and transparency.

From 257 initially identified records, 184 studies remained after duplicate removal. Following the title and abstract screening, 73 full text articles were assessed for eligibility. Ultimately, 54 studies met all inclusion criteria and were included in the final review. However, pregnancy introduces diagnostic challenges related to IOP assessment, variability in individual responses, and the possibility of paradoxical IOP elevation. The extent of IOP reduction during pregnancy may be influenced by physiological and demographic factors such as age, parity, systemic blood pressure, and central corneal thickness (CCT), all of which can modulate the degree of IOP change. For instance, multiparous women often exhibit greater IOP decreases than primigravidas. Beta-blockers remain among the most frequently prescribed agents during pregnancy; however, punctal occlusion is recommended to reduce systemic absorption. Alternative treatment options, including selective laser trabeculoplasty (SLT) and minimally invasive glaucoma surgery (MIGS), may be considered based on disease severity and gestational stage.

The findings advocate for a patient-centered approach that integrates evidence-based strategies to preserve maternal vision while ensuring fetal well-being. Ongoing research and interdisciplinary collaboration will be essential in developing new approaches while safeguarding both maternal and fetal health.